Organization Active NPI

Comprehensive Pain Medicine, Inc.

  • Specialist
  • Pensacola, FL
National Provider Identifier
1881659704
Registry record updated Jun 17, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
COMPREHENSIVE PAIN MEDICINE, INC.
Practice address
510 Corday St
Pensacola, FL 32503-2021
Phone
(850) 969-9804
Fax
(850) 475-1472
NPI assigned
Apr 20, 2006
Last updated
Jun 17, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2009

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

Authorized official

Name
Dr. Ruben Berrocal Timmons, M.D.
Title
Medical Director
Phone
(850) 968-9804

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X Primary

Addresses

Primary practice location

510 Corday St
Pensacola, FL 32503-2021

Mailing address

510 Corday St
Pensacola, FL 32503-2021
Phone (850) 969-9804

Other identifiers 3

IdentifierTypeStateIssuer
39810OtherFLBCBS GROUP NUMBER
529600860MedicaidAL
372440900MedicaidFL

National Provider Directory

National Provider Directory

Locations

1034 Mar Walt Dr
Unit 300
Ft Walton Bch, FL 32547
Phone (850) 315-9363

928A Mar Walt Dr
Ft Walton Bch, FL 32547
Phone (850) 969-9804

1040 Gulf Breeze Pkwy
Ste 205
Gulf Breeze, FL 32561
Phone (850) 469-0642

12815 US Highway 98 W
Miramar Beach, FL 32550
Phone (850) 269-0111

3754 Highway 90
Ste 120
Pace, FL 32571
Phone (850) 994-1883

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": "1145491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245196800000",
    "number": "1881659704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 CORDAY ST",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325032021",
            "telephone_number": "850-969-9804",
            "fax_number": "850-475-1472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 CORDAY ST",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325032021",
            "telephone_number": "850-969-9804",
            "fax_number": "850-475-1472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPREHENSIVE PAIN MEDICINE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-20",
        "last_updated": "2009-06-17",
        "status": "A",
        "authorized_official_last_name": "TIMMONS",
        "authorized_official_first_name": "RUBEN",
        "authorized_official_middle_name": "BERROCAL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "850-968-9804",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "39810",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529600860",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "372440900",
            "state": "FL"
        }
    ],
    "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 Jun 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.