Back to Life Pain Center, LLC

Primary specialty

Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X

Legal business name

BACK TO LIFE PAIN CENTER, LLC

Practice address

410 Creekstone RDG
Woodstock, GA 30188-3740

Phone

(678) 909-0911

Fax

(678) 909-0912

NPI assigned

Nov 7, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Konstantin Sergeyevich Tsymbalov, DONPI 1750607586

Title

Owner

Phone

(678) 909-0911

Specialties & licenses 1

Addresses

Other names 1

• Back To Life Pain Center Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

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

• Konstantin Sergeyevich Tsymbalov, D.O.

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Acworth, GA
  • NPI 1750607586

  GA

  Medicare reassignment Authorized official

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

{
    "created_epoch": "1541548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597363200000",
    "number": "1982172060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 CREEKSTONE RDG",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301883740",
            "telephone_number": "678-909-0911",
            "fax_number": "678-909-0912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 CREEKSTONE RDG",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301883740",
            "telephone_number": "678-909-0911",
            "fax_number": "678-909-0912"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3459 Acworth Due West Rd NW",
            "address_2": "Suite 117",
            "address_purpose": "LOCATION",
            "city": "Acworth",
            "state": "GA",
            "postal_code": "30101",
            "country_code": "US",
            "telephone_number": "678-521-1105",
            "fax_number": "678-909-0912",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BACK TO LIFE PAIN CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-07",
        "last_updated": "2020-08-14",
        "certification_date": "2020-08-14",
        "status": "A",
        "authorized_official_last_name": "TSYMBALOV",
        "authorized_official_first_name": "KONSTANTIN",
        "authorized_official_middle_name": "SERGEYEVICH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-909-0911",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "ktsymbalov@yahoo.com",
            "affiliation": "N",
            "address_1": "3459 Acworth Due West Rd NW",
            "address_2": "Suite 117",
            "city": "Acworth",
            "state": "GA",
            "country_code": "US",
            "postal_code": "30101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Back To Life Pain Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Diana Catalina Avila, MSW
• Matthew Payom Ayers, PT, DPT
• Aylo Health, LLC
• Aylo Health, LLC
• Back to Basic Health Chiropractic
• Elisabeth Baertlein
• Keheley Bailey, LCSW
• Peter Bailey, APC
• A Tyler Baird, D.M.D.
• D Thad Baird, D.M.D.

• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Woodstock, GA
• Providers in Woodstock, GA by specialty
• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2020; 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.