NPIMap

Organization Active NPI

Ny Premier Medical Practice, PC

Doing business as NY Spine Care Interventional Pain Management

  • Interventional Pain Medicine Physician
  • Flushing, NY
National Provider Identifier
1881986743
Registry record updated Aug 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
232226 Issued in NY
Legal business name
NY PREMIER MEDICAL PRACTICE, PC
Doing business as
NY Spine Care Interventional Pain Management
Practice address
188-16 Northern Blvd
Flushing, NY 11358-2811
Phone
(718) 762-7000
Fax
(718) 762-7002
NPI assigned
May 11, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2023

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

Authorized official

Name
Michael I Jo
Title
Office Manager
Phone
(347) 804-7532

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208VP0014X 232226 NY Primary

Addresses

Primary practice location

188-16 Northern Blvd
Flushing, NY 11358-2811

Mailing address

188-16 Northern Blvd
Flushing, NY 11358-2811
Phone (718) 762-7000

Other names 1

  • NY Spine Care Interventional Pain Management Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110603000054 NY Part B Supplier - Clinic/Group Practice 8022295807 Receives reassigned benefits from 8 practitioners
Practice locations: Flushing, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2028151Ny Spine Care Interventional Pain Management188-16 Northern Blvd, Flushing, NY 11358Certificate of waiverAug 9, 2027

National Provider Directory

National Provider Directory

Locations

18816 Northern Blvd
Fl 1
Flushing, NY 11358

18816 Northern Blvd
Flushing, NY 11358
Phone (718) 762-7000

Practitioners & affiliated clinicians

Practitioners 12

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

NPI Registry JSON

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

{
    "created_epoch": "1305072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690848000000",
    "number": "1881986743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "188-16 NORTHERN BLVD",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113582811",
            "telephone_number": "718-762-7000",
            "fax_number": "718-762-7002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "188-16 NORTHERN BLVD",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113582811",
            "telephone_number": "718-762-7000",
            "fax_number": "718-762-7002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NY PREMIER MEDICAL PRACTICE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-11",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A",
        "authorized_official_last_name": "JO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "347-804-7532"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "NY",
            "license": "232226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NY Spine Care Interventional Pain Management",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NY Spine Care Interventional Pain Management",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Flushing, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.