NPIMap

Organization Active NPI

Elpis Pain Management Center LLC

  • Pain Medicine Physician
  • O'Fallon, MO
National Provider Identifier
1841544251
Registry record updated Apr 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
License
2006017511 Issued in MO
Legal business name
ELPIS PAIN MANAGEMENT CENTER LLC
Practice address
4122 Keaton Crossing Blvd
Suite 102
O Fallon, MO 63368-8218
Phone
(636) 329-9077
NPI assigned
Nov 7, 2012
Last updated
Apr 26, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2015

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

Authorized official

Name
Mr. Vivek K Manchanda, M.D.NPI 1083729941
Title
President
Phone
(636) 329-9077

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 2006017511 MO
Pain Medicine Physician 208VP0000X 2006017511 MO Primary

Addresses

Primary practice location

4122 Keaton Crossing Blvd
Suite 102
O Fallon, MO 63368-8218

Mailing address

4122 Keaton Crossing Blvd
Suite 102
O Fallon, MO 63368-8218
Phone (636) 329-9077

Other identifiers 5

IdentifierTypeStateIssuer
DV4098OtherMORAILROAD MEDICARE GROUP PTAN
P00836305OtherMORAILROAD MEDICARE
1083729941MedicaidMO
431560263OtherMOTRICARE WEST
7233350001OtherMONORIDIAN , MEDICARE DME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130118000436 MO Part B Supplier - Clinic/Group Practice 5193978328 Receives reassigned benefits from 1 practitioner
Practice locations: O Fallon, MO

National Provider Directory

National Provider Directory

Locations

4122 Keaton Crossing Blvd
Ste 102
O Fallon, MO 63368
Phone (636) 329-9077

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1352246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430006400000",
    "number": "1841544251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4122 KEATON CROSSING BLVD",
            "address_2": "SUITE 102",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633688218",
            "telephone_number": "636-329-9077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4122 KEATON CROSSING BLVD",
            "address_2": "SUITE 102",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633688218",
            "telephone_number": "636-329-9077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELPIS PAIN MANAGEMENT CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-07",
        "last_updated": "2015-04-26",
        "status": "A",
        "authorized_official_last_name": "MANCHANDA",
        "authorized_official_first_name": "VIVEK",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "636-329-9077",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MO",
            "license": "2006017511",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "MO",
            "license": "2006017511",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP PTAN",
            "identifier": "DV4098",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00836305",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1083729941",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE WEST",
            "identifier": "431560263",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORIDIAN , MEDICARE DME",
            "identifier": "7233350001",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in O'Fallon, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2015; 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.