Southcoast Spine and Pain LLC

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

Legal business name

SOUTHCOAST SPINE AND PAIN LLC

Practice address

440 Society Hill Dr Ste 202
Aiken, SC 29803-1755

Phone

(803) 226-0102

Fax

(803) 226-0384

NPI assigned

Mar 9, 2022

Organization subpart

No

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

Authorized official

Name

Daryan Long

Title

Billing Manager

Phone

(843) 224-8086

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

Practitioners 2

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

• Russell K Daniel, M.D.

  • Pain Medicine (Anesthesiology) Physician
  • Aiken, SC
  • NPI 1376540260
  Medicare reassignment NPD
• Michael Edward Spillane, PA-C

  • Physician Assistant
  • Aiken, SC
  • NPI 1114979689
  Medicare reassignment

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

{
    "created_epoch": "1646784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665014400000",
    "number": "1891442869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 SOCIETY HILL DR STE 202",
            "city": "AIKEN",
            "state": "SC",
            "postal_code": "298031755",
            "telephone_number": "803-226-0102",
            "fax_number": "803-226-0384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 SOCIETY HILL DR STE 202",
            "city": "AIKEN",
            "state": "SC",
            "postal_code": "298031755",
            "telephone_number": "803-226-0102",
            "fax_number": "803-226-0384"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3070 N Highway 17 Ste 202",
            "address_purpose": "LOCATION",
            "city": "Mount Pleasant",
            "state": "SC",
            "postal_code": "294669300",
            "country_code": "US",
            "telephone_number": "803-226-0102",
            "fax_number": "803-226-0384",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHCOAST SPINE AND PAIN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-09",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "DARYAN",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "843-224-8086"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• South Carolina Dhec
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• Southeast Homecare & Respiratory Services
• Southern Anesthesia of Augusta LLC
• Southern Dermatology LLC
• Southern Dermatology Medical LLC
• Southern Healthstyles, Inc.

• Pain Medicine (Anesthesiology) Physician in Aiken, SC
• Providers in Aiken, SC by specialty
• Pain Medicine (Anesthesiology) Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2022; 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.