Basic Information
| Provider Information | |||||||||
| NPI: | 1265488308 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CLINICAL PAIN MANAGEMENT ASSOCIATES, PC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 333 N OXFORD VALLEY RD | ||||||||
| Address2: | SUITE 510 | ||||||||
| City: | FAIRLESS HILLS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190302624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159493100 | ||||||||
| FaxNumber: | 2159498521 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 N OXFORD VALLEY RD | ||||||||
| Address2: | SUITE 510 | ||||||||
| City: | FAIRLESS HILLS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190302624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159493100 | ||||||||
| FaxNumber: | 2159498521 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 06/21/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | RIZZO | ||||||||
| AuthorizedOfficialFirstName: | FRANK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2157850145 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 50001468 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 962740 | 01 | PA | PA BLUE SHIELD | OTHER | 33029 | 01 | PA | KEYSTONE MERCY | OTHER | A3190544 | 01 | PA | OXFORD | OTHER | DD1386 | 01 | PA | RAILROAD MEDICARE | OTHER | 0422856000 | 01 | PA | KEYSTONE CENTRAL | OTHER | 0964596 | 01 | PA | AETNA | OTHER | DB0435 | 01 | PA | RAILROAD MEDICARE | OTHER | 0422856000 | 01 | PA | KEYSTONE HEALTH PLAN EAST | OTHER | 1201547 | 01 | NJ | AETNA | OTHER | 962740 | 01 | PA | PERSONAL CHOICE | OTHER | 33029 | 01 | PA | HORIZON MERCY | OTHER | 0073566950002 | 05 | PA | MEDICAID | 0422856000 | 01 | PA | AMERIHEALTH | OTHER |