NPIMap

Organization Active NPI

Interventional Pain Specialists of Wisconsin, SC

  • Pain Medicine (Anesthesiology) Physician
  • Rice Lake, WI
National Provider Identifier
1992800791
Registry record updated Apr 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
34036 Issued in WI
Legal business name
INTERVENTIONAL PAIN SPECIALISTS OF WISCONSIN, SC
Practice address
2021 Cenex Dr Unit J
Rice Lake, WI 54868-1892
Phone
(715) 234-7246
Fax
(715) 234-7242
NPI assigned
Sep 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2024

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

Authorized official

Name
John K Brendel Jr., MDNPI 1073596052
Title
Owner
Phone
(715) 234-7246

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207LP2900X 34036 WI Primary

Addresses

Primary practice location

2021 Cenex Dr Unit J
Rice Lake, WI 54868-1892

Mailing address

2021 Cenex Dr Unit J
Rice Lake, WI 54868-1892
Phone (715) 234-7246

Other identifiers 3

IdentifierTypeStateIssuer
31913700MedicaidWI
397524621000OtherWIBLUE CROSS WI
34036OtherWIWI LICENSE NUMBER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040312000438 WI Part B Supplier - Clinic/Group Practice 4284523739 Receives reassigned benefits from 2 practitioners
Practice locations: Amery, WI; Cumberland, WI; Hayward, WI; Hudson, WI; Rice Lake, WI

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 6

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": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713139200000",
    "number": "1992800791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2021 CENEX DR UNIT J",
            "city": "RICE LAKE",
            "state": "WI",
            "postal_code": "548681892",
            "telephone_number": "715-234-7246",
            "fax_number": "715-234-7242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2021 CENEX DR UNIT J",
            "city": "RICE LAKE",
            "state": "WI",
            "postal_code": "548681892",
            "telephone_number": "715-234-7246",
            "fax_number": "715-234-7242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERVENTIONAL PAIN SPECIALISTS OF WISCONSIN, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A",
        "authorized_official_last_name": "BRENDEL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "715-234-7246",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "WI",
            "license": "34036",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31913700",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS WI",
            "identifier": "397524621000",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WI LICENSE NUMBER",
            "identifier": "34036",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rice Lake, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 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.