NPIMap

Organization Active NPI

360 Pain and Spine PLLC

Doing business as Renner Pain And Spine

  • Pain Medicine (Anesthesiology) Physician
  • Richardson, TX
National Provider Identifier
1821611153
Registry record updated Aug 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
Legal business name
360 PAIN AND SPINE PLLC
Doing business as
Renner Pain And Spine
Practice address
3009 E Renner Rd Ste 100
Richardson, TX 75082-3572
Phone
(469) 589-1871
Fax
(469) 589-1872
NPI assigned
May 21, 2020
Last updated
Aug 18, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2022

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

Authorized official

Name
Obaid Malik, MDNPI 1972946077
Title
Director
Phone
(469) 589-1871

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X NU
Pain Medicine (Anesthesiology) Physician 207LP2900X NU Primary
Neurology Physician 2084N0400X NU
Interventional Pain Medicine Physician 208VP0014X NU

Addresses

Primary practice location

3009 E Renner Rd Ste 100
Richardson, TX 75082-3572

Mailing address

3009 E Renner Rd Ste 100
Richardson, TX 75082-3572
Phone (469) 589-1871

Other names 1

  • Renner Pain And Spine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200611001534 TX Part B Supplier - Clinic/Group Practice 6103247598 Receives reassigned benefits from 13 practitioners
Practice locations: Plano, TX; Richardson, TX
O20220712001985 TX DME Supplier - Physician - Interventional Pain ManagementDME Supplier - Physician - Neurology 6103247598 Practice locations: Richardson, TX

National Provider Directory

National Provider Directory

Locations

1308 Village Creek Dr
Ste 2000
Plano, TX 75093
Phone (469) 589-1871

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/21996/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1590019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660780800000",
    "number": "1821611153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3009 E RENNER RD STE 100",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750823572",
            "telephone_number": "469-589-1871",
            "fax_number": "469-589-1872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3009 E RENNER RD STE 100",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750823572",
            "telephone_number": "469-589-1871",
            "fax_number": "469-589-1872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "360 PAIN AND SPINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-21",
        "last_updated": "2022-08-18",
        "certification_date": "2022-08-18",
        "status": "A",
        "authorized_official_last_name": "MALIK",
        "authorized_official_first_name": "OBAID",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "469-589-1871",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Renner Pain And Spine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Renner Pain And Spine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Richardson, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.