JP Anesthesiology, Inc

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

A86588 Issued in CA

Legal business name

JP ANESTHESIOLOGY, INC

Practice address

15447 W Sand St
Victorville, CA 92392-2904

Phone

(760) 843-9679

Fax

(760) 245-3618

NPI assigned

Oct 10, 2006

Organization subpart

No

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

Authorized official

Name

Joe Park, M.D.NPI 1083645832

Title

President

Phone

(760) 843-9679

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Advanced Pain Management Center Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joe Park, M.D.

  • Pain Medicine (Anesthesiology) Physician
  • Victorville, CA
  • NPI 1083645832
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1821186776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15447 WEST SAND STREET",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923924500",
            "telephone_number": "760-843-9679",
            "fax_number": "760-245-3618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15447 W SAND ST",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923922904",
            "telephone_number": "760-843-9679",
            "fax_number": "760-245-3618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JP ANESTHESIOLOGY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "JOE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "760-843-9679",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "CA",
            "license": "A86588",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A865880",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "ZZZ02746Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DF4286",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Pain Management Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pain Medicine (Anesthesiology) Physician in Victorville, CA
• Providers in Victorville, CA by specialty
• Pain Medicine (Anesthesiology) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.