MEDICARE: PAIN AND AGING MANAGEMENT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	163W00000X	Registered Nurse
2	207LP2900X	Pain Medicine (Anesthesiology) Physician
3	208100000X	Physical Medicine & Rehabilitation Physician
4	332B00000X	Durable Medical Equipment & Medical Supplies
5	363A00000X	Physician Assistant
6	208VP0000X	Pain Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	226700	OTHER	IN	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000366888	OTHER	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124100961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIN AND AGING MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	7951 SHOAL CREEK BLVD STE 300
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78757-7582
Country	:	US
Telephone Number	:	512-584-8404
Fax Number	:	812-376-8625

Provider Business Practice Location Address
First Line	:	2400 NORTHPARK DR STE 20
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-4467
Country	:	US
Telephone Number	:	812-376-0700
Fax Number	:	812-376-8625

Authorized Official
Title or Position	:	CEO
Name	:	SANDFORD MATTHEW SCHOCKET
Credential	:
Telephone Number	:	512-584-8404

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	05/17/2024

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Directions to “PAIN AND AGING MANAGEMENT LLC ” Practice Location

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