NPIMap

Organization Active NPI

Innovative Pain Management Medical Group

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • National City, CA
National Provider Identifier
1902330285
Registry record updated Apr 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
License
A73257 Issued in CA
Legal business name
INNOVATIVE PAIN MANAGEMENT MEDICAL GROUP
Practice address
610 Euclid Ave
Suite 301
National City, CA 91950-2951
Phone
(619) 434-4019
Fax
(619) 434-4023
NPI assigned
Apr 13, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2017

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

Authorized official

Name
Brenton D Wynn, M.D.
Title
President
Phone
(619) 434-4019

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X A73257 CA Primary
Pain Clinic/Center 261QP3300X CA

Addresses

Primary practice location

610 Euclid Ave
Suite 301
National City, CA 91950-2951

Mailing address

333 W Harbor Dr
Suite 126
San Diego, CA 92101-7709
Phone (619) 434-4019

National Provider Directory

National Provider Directory

Locations

333 W Harbor Dr
Ste 126
San Diego, CA 92101

Practitioners & affiliated clinicians

Practitioners 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1492041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492041600000",
    "number": "1902330285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 W HARBOR DR",
            "address_2": "SUITE 126",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921017709",
            "telephone_number": "619-434-4019",
            "fax_number": "619-434-4023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 EUCLID AVE",
            "address_2": "SUITE 301",
            "city": "NATIONAL CITY",
            "state": "CA",
            "postal_code": "919502951",
            "telephone_number": "619-434-4019",
            "fax_number": "619-434-4023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE PAIN MANAGEMENT MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-13",
        "last_updated": "2017-04-13",
        "status": "A",
        "authorized_official_last_name": "WYNN",
        "authorized_official_first_name": "BRENTON",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "619-434-4019",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "CA",
            "license": "A73257",
            "primary": true
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": "CA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in National City, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2017; 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.