NPIMap

Organization Active NPI

East West Integrated Pain & Rehab Center LLC

  • Physical Therapist
  • Albuquerque, NM
National Provider Identifier
1932398146
Registry record updated Oct 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2074 Issued in NM
Legal business name
EAST WEST INTEGRATED PAIN & REHAB CENTER LLC
Practice address
6501 Eagle Rock Ave NE
Ste A6
Albuquerque, NM 87113-2479
Phone
(505) 797-5400
Fax
(505) 797-2905
NPI assigned
Oct 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2011

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

Authorized official

Name
Dr. James Dalkyu Park, DOM PTNPI 1255396719
Title
Business Owner
Phone
(505) 514-2900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
AcupuncturistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 171100000X 866RX1 NM
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X 2074 NM Primary

Addresses

Primary practice location

6501 Eagle Rock Ave NE
Ste A6
Albuquerque, NM 87113-2479

Mailing address

6501 Eagle Rock Ave NE
Suite A6
Albuquerque, NM 87113-2479
Phone (505) 797-5400

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081210000344 NM Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5294896130 Receives reassigned benefits from 1 practitioner
Practice locations: Albuquerque, NM

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1193184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319673600000",
    "number": "1932398146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6501 EAGLE ROCK AVE NE",
            "address_2": "SUITE A6",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871132479",
            "telephone_number": "505-797-5400",
            "fax_number": "505-797-2905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6501 EAGLE ROCK AVE NE",
            "address_2": "STE A6",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871132479",
            "telephone_number": "505-797-5400",
            "fax_number": "505-797-2905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST WEST INTEGRATED PAIN & REHAB CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-24",
        "last_updated": "2011-10-27",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "DALKYU",
        "authorized_official_title_or_position": "BUSINESS OWNER",
        "authorized_official_telephone_number": "505-514-2900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DOM PT"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": "NM",
            "license": "866RX1",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "NM",
            "license": "2074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2011; 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.