NPIMap

Organization Active NPI

Dynamic Pain & Wellness PLLC

  • Pain Medicine Physician
  • Pensacola, FL
National Provider Identifier
1871064360
Registry record updated Dec 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
Legal business name
DYNAMIC PAIN & WELLNESS PLLC
Practice address
1851 Saint Mary Ave
Pensacola, FL 32501-1053
Phone
(850) 226-6801
Fax
(877) 413-5104
NPI assigned
Dec 10, 2018
Last updated
Dec 10, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
DYNAMIC PAIN & WELLNESS PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 10, 2018

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

Authorized official

Name
Sarah Bailey
Title
Credentialing
Phone
(850) 226-6801

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208VP0000X Primary

Addresses

Primary practice location

1851 Saint Mary Ave
Pensacola, FL 32501-1053

Mailing address

930 Mar Walt Drive
Unit C
Fort Walton Beach, FL 32547
Phone (850) 226-6801

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190531001822 FL DME Supplier - Physician - General PracticeDME Supplier - Physician - Interventional Pain Management 8527364058 Practice locations: Pensacola, FL

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Dynamic Pain Wellness LLC8 organizations share this tax ID, including this one
Part of
Dynamic Pain Wellness LLC

Other organizations with this tax ID 7

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1544400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544400000000",
    "number": "1871064360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 MAR WALT DRIVE",
            "address_2": "UNIT C",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "32547",
            "telephone_number": "850-226-6801",
            "fax_number": "877-413-5104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1851 SAINT MARY AVE",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325011053",
            "telephone_number": "850-226-6801",
            "fax_number": "877-413-5104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC PAIN & WELLNESS PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DYNAMIC PAIN & WELLNESS PLLC",
        "enumeration_date": "2018-12-10",
        "last_updated": "2018-12-10",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "SARAH",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "850-226-6801"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pensacola, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 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.