Advanced Interventional Pain Center LLC

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

Legal business name

ADVANCED INTERVENTIONAL PAIN CENTER LLC

Practice address

613 W Lincoln Rd Ste a
Kokomo, IN 46902-3460

Phone

(765) 319-3522

Fax

(765) 450-6161

NPI assigned

Jul 14, 2006

Last updated

Jul 4, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Pattanam Dorai Srinivasan, MD

Title

Ceo

Phone

(765) 891-0721

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Panchapakesan Pranatharthi Haran, MD

  • Anesthesiology Physician
  • Kokomo, IN
  • NPI 1467473330
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593820800000",
    "number": "1821014580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 N GRANVILLE AVE",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473032110",
            "telephone_number": "765-284-0493",
            "fax_number": "765-284-2434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "613 W LINCOLN RD STE A",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469023460",
            "telephone_number": "765-319-3522",
            "fax_number": "765-450-6161"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "394 N Mount Zion Rd",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "IN",
            "postal_code": "460528330",
            "country_code": "US",
            "telephone_number": "765-891-0721",
            "fax_number": "765-284-2434",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ADVANCED INTERVENTIONAL PAIN CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2020-07-04",
        "certification_date": "2020-07-04",
        "status": "A",
        "authorized_official_last_name": "SRINIVASAN",
        "authorized_official_first_name": "PATTANAM",
        "authorized_official_middle_name": "DORAI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "765-891-0721",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200532650A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Interventional Pain Medicine Physician in Kokomo, IN
• Providers in Kokomo, IN by specialty
• Interventional Pain Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.