Oklahoma Spine Diagnostic and Pain Treatment Center PLLC

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

19113 Issued in OK

Legal business name

OKLAHOMA SPINE DIAGNOSTIC AND PAIN TREATMENT CENTER PLLC

Practice address

3200 Medical Park Dr
Shawnee, OK 74804-5014

Phone

(405) 878-9490

Fax

(405) 878-9492

NPI assigned

Feb 19, 2007

Organization subpart

No

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

Authorized official

Name

Melenie Nachimson

Title

Credentialing Specialist

Phone

(405) 775-9350

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Practitioners 1

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

• Khalid A Khan, MD

  • Pain Medicine (Anesthesiology) Physician
  • Shawnee, OK
  • NPI 1306814777
  Medicare reassignment NPD

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

{
    "created_epoch": "1171843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355875200000",
    "number": "1841334166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14459",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731130459",
            "telephone_number": "405-775-9350",
            "fax_number": "405-775-9360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 MEDICAL PARK DR",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748045014",
            "telephone_number": "405-878-9490",
            "fax_number": "405-878-9492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OKLAHOMA SPINE DIAGNOSTIC AND PAIN TREATMENT CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-19",
        "last_updated": "2012-12-19",
        "status": "A",
        "authorized_official_last_name": "NACHIMSON",
        "authorized_official_first_name": "MELENIE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "405-775-9350"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "OK",
            "license": "19113",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "DH1384",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200119720A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME - CIGNA GOVERNMENT SERVICES",
            "identifier": "6252130001",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Oklahoma Mental Health Council
• Oklahoma Mental Health Council
• Oklahoma Orthopedics & Sports Medicine
• Oklahoma Rehabilitation Clinic
• Oklahoma Speech Consultants, PLLC
• Oklahoma Sports and Orthopedics Institute PLLC
• Leanna Rae Olsen, R.N., C.M.T.
• Eric Olson
• Kellie Sue Ophus, D.D.S.
• Opshaw, LLC

• Interventional Pain Medicine Physician in Shawnee, OK
• Providers in Shawnee, OK by specialty
• Interventional Pain Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2012; 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.