Cornell Pain Clinic LLC

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

MD178982 Issued in OR

Legal business name

CORNELL PAIN CLINIC LLC

Practice address

15455 NW Greenbrier Pkwy Ste 130
Beaverton, OR 97006

Phone

(503) 376-9200

Fax

(503) 376-9201

NPI assigned

Jan 16, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Suresh Chand, MDNPI 1922386614

Title

Medical Director

Phone

(503) 376-9200

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• Suresh Chand MD Doing business as
• Cornell Pain Clinic Former legal business name

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Tax ID family

Cornell Pain Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Cornell Pain Clinic

  • Pain Medicine Physician
  • Beaverton, OR
  • NPI 1649773490
  NPD tax ID

Locations

Practitioners 1

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

• Suresh Chand, MD, MBA

  • Interventional Pain Medicine Physician
  • Beaverton, OR
  • NPI 1922386614
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1516060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530144000000",
    "number": "1861900516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15455 NW GREENBRIER PKWY STE 130",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970068115",
            "telephone_number": "503-376-9200",
            "fax_number": "503-376-9201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15455 NW GREENBRIER PKWY STE 130",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "97006",
            "telephone_number": "503-376-9200",
            "fax_number": "503-376-9201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNELL PAIN CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-16",
        "last_updated": "2018-06-28",
        "status": "A",
        "authorized_official_last_name": "CHAND",
        "authorized_official_first_name": "SURESH",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "503-376-9200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "OR",
            "license": "MD178982",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500710995",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Suresh Chand MD",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Suresh Chand MD",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cornell Pain Clinic",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Christopher R Corbett, PSYD
• Erin Corbin
• Kristen Corbin, BDC.BD.70136630
• Rachel Mehana Cordery, LMT
• Cornell Pain Clinic
• Cornell Urgent Care
• Cornerstone Caregiving, Inc
• Maddelyne Mishell Corrales
• Michelle K Correia-Jeffers, DPT
• Cory Correia

• Interventional Pain Medicine Physician in Beaverton, OR
• Providers in Beaverton, OR by specialty
• Interventional Pain Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2018; 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.