NPIMap

Organization Active NPI

Providence Pain Management Center, P.a.

Doing business as Innovative Pain Solutions Centers

  • Interventional Pain Medicine Physician
  • Bowie, MD
National Provider Identifier
1932506284
Registry record updated May 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
D0066706 Issued in MD
Legal business name
PROVIDENCE PAIN MANAGEMENT CENTER, P.A.
Doing business as
Innovative Pain Solutions Centers
Practice address
6911 Laurel Bowie Rd
Suite 212
Bowie, MD 20715-1712
Phone
(301) 755-9500
Fax
(301) 747-6017
NPI assigned
Dec 2, 2014
Last updated
May 22, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2024

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

Authorized official

Name
Joseph Oppong Jr., M.D.NPI 1174664007
Title
Director/President
Phone
(301) 755-9500

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
Pain Medicine (Anesthesiology) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207LP2900X D0066706 MD
Interventional Pain Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208VP0014X D0066706 MD Primary

Addresses

Primary practice location

6911 Laurel Bowie Rd
Suite 212
Bowie, MD 20715-1712

Mailing address

6911 Laurel Bowie Rd
Suite 212
Bowie, MD 20715-1712
Phone (301) 755-9500

Other practice location 1

201 Pine Bluff Rd Ste 1
Salisbury, MD 21801-7163
Phone (410) 648-2000

Other names 1

  • Innovative Pain Solutions Centers Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150429001059 DC Part B Supplier - Clinic/Group Practice 3678892486 Receives reassigned benefits from 5 practitioners
Practice locations: Bowie, MD
O20190312000429 MD Part B Supplier - Clinic/Group Practice 3678892486 Receives reassigned benefits from 5 practitioners
Practice locations: Salisbury, MD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1417478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716336000000",
    "number": "1932506284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6911 LAUREL BOWIE RD",
            "address_2": "SUITE 212",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207151712",
            "telephone_number": "301-755-9500",
            "fax_number": "301-747-6017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6911 LAUREL BOWIE RD",
            "address_2": "SUITE 212",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207151712",
            "telephone_number": "301-755-9500",
            "fax_number": "301-747-6017"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "201 Pine Bluff Rd Ste 1",
            "address_purpose": "LOCATION",
            "city": "Salisbury",
            "state": "MD",
            "postal_code": "218017163",
            "country_code": "US",
            "telephone_number": "410-648-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROVIDENCE PAIN MANAGEMENT CENTER, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-02",
        "last_updated": "2024-05-22",
        "certification_date": "2024-05-22",
        "status": "A",
        "authorized_official_last_name": "OPPONG",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "DIRECTOR/PRESIDENT",
        "authorized_official_telephone_number": "301-755-9500",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "MD",
            "license": "D0066706",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "MD",
            "license": "D0066706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Innovative Pain Solutions Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bowie, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2024; 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.