Organization Active NPI

Peninsula Pain Clinic, PLLC

  • Pain Clinic/Center
  • Bremerton, WA
National Provider Identifier
1912376005
Registry record updated Jul 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Clinic/CenterTaxonomy code 261QP3300X
Legal business name
PENINSULA PAIN CLINIC, PLLC
Practice address
2601 Cherry Ave Ste 200
Bremerton, WA 98310-4208
Phone
(360) 415-9110
Fax
(360) 479-0265
NPI assigned
Sep 18, 2015
Organization subpart
Yes
Parent organization
PENINSULA PAIN CLINIC, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 22, 2019

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

Authorized official

Name
Terry Pexton, DO
Title
Medical Director
Phone
(360) 415-9110

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Pain Clinic/Center 261QP3300X Primary
Non-Pharmacy Dispensing Site 332900000X OP60339103 WA

Addresses

Primary practice location

2601 Cherry Ave Ste 200
Bremerton, WA 98310-4208

Mailing address

2980 N Beverly Glen Cir Ste 100
Los Angeles, CA 90077-1728
Phone (310) 943-4180

National Provider Directory

National Provider Directory
Part of
Peninsula Pain Clinic P

Practitioners & affiliated clinicians

Practitioners 1

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": "1442534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563753600000",
    "number": "1912376005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2980 N BEVERLY GLEN CIR STE 100",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900771728",
            "telephone_number": "310-943-4180",
            "fax_number": "888-431-8819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 CHERRY AVE STE 200",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983104208",
            "telephone_number": "360-415-9110",
            "fax_number": "360-479-0265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA PAIN CLINIC, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PENINSULA PAIN CLINIC, PLLC",
        "enumeration_date": "2015-09-18",
        "last_updated": "2019-07-22",
        "status": "A",
        "authorized_official_last_name": "PEXTON",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "360-415-9110",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "WA",
            "license": "OP60339103",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bremerton, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2019; 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.