Medical School Information |
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Medical School Name
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OTHER
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Individual professional's medical school
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Graduation Year
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2003
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Individual professional's medical school graduation year
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Primary Specialty
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INTERVENTIONAL PAIN MANAGEMENT
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Primary medical specialty reported by the individual professional in the selected enrollment
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Secondary Specialty 1
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ANESTHESIOLOGY
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First secondary medical specialty reported by the individual professional in the selected enrollment
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All Secondary Specialties
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ANESTHESIOLOGY
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All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas
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Practice Information |
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Organization Legal Name
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INTERVENTIONAL PAIN INSTITUTE, LLC
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Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
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Group Practice PAC ID
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1153451919
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Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
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Number of Group Practice members
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3
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Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
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Line 1 Street Address
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17300 N OUTER 40
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Group Practice or individual's line 1 address
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Line 2 Street Address
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100 INTERVENTIONAL PAIN INSTITUTE LLC
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Group Practice or individual's line 2 address
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City
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CHESTERFIELD
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Group Practice or individual's city
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State
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MO
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Group Practice or individual's state
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Zip Code
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630051364
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Group Practice or individual's zip code (9 digits when available)
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Phone Number
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6369332243
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Phone number is listed only when there is a single phone number available for the practice location address
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Hospital(s) Affiliation Information |
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Hospital Affiliation CCN 1
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260023
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Medicare CCN of hospital where individual professional provides service 1
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Hospital Affiliation LBN 1
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MERCY HOSPITAL JEFFERSON
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Legal business name of hospital where individual professional provides service 1
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Hospital Affiliation CCN 2
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260104
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Medicare CCN of hospital where individual professional provides service 2
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Hospital Affiliation LBN 2
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SSM DEPAUL HEALTH CENTER
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Legal business name of hospital where individual professional provides service 2
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Hospital Affiliation CCN 3
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260179
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Medicare CCN of hospital where individual professional provides service 3
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Hospital Affiliation LBN 3
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ST LUKES HOSPITAL
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Legal business name of hospital where individual professional provides service 3
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Hospital Affiliation CCN 4
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260163
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Medicare CCN of hospital where individual professional provides service 4
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Hospital Affiliation LBN 4
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PARKLAND HEALTH CENTER
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Legal business name of hospital where individual professional provides service 4
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Hospital Affiliation CCN 5
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260020
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Medicare CCN of hospital where individual professional provides service 5
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Hospital Affiliation LBN 5
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MERCY HOSPITAL ST LOUIS
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Legal business name of hospital where individual professional provides service 5
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Professional Accepts Medicare Assignment
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Y
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