ADVANCED SPINE AND PAIN LLC (NPI# 1629679923) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629679923 |
| Entity Type | Organization |
| Organization Name | ADVANCED SPINE AND PAIN LLC |
| Practice Address |
4566 E Inverness Ave Ste 205 Mesa AZ 85206-4634 |
| Mailing Address |
2525 W Greenway Rd Ste 125 Phoenix AZ 85023-4226 |
| Practice Telephone | 4806400513 |
| Mailing Telephone | 4806400513 |
| Enumeration Date | 2020-11-03 |
| Last Update Date | 2020-11-03 |
| Authorized Official Name | JARRETT MICHAEL LEATHEM (MD, OWNER) |
| Authorized Official Telephone | 8606702412 |
| Is Organization Subpart | Y |
| Parent Organization Name | ADVANCED SPINE AND PAIN LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207LP2900X |
Anesthesiology Specialization: Pain Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 208VP0000X |
Pain Medicine Specialization: Pain Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 2081P2900X |
Physical Medicine & Rehabilitation Specialization: Pain Medicine |
Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710508304 | Advanced Spine and Pain LLC | Pain Medicine | 2186 Route 27 Ste 2d, North Brunswick, NJ 08902-1137 | 2020-05-05 |
| 1780157222 | Advanced Spine and Pain LLC | Physical Medicine & Rehabilitation | 432 Lakehurst Rd Fl 1, Toms River, NJ 08755-7333 | 2019-01-08 |
| 1356950653 | Advanced Spine and Pain LLC | Anesthesiology | 2525 W Greenway Rd Ste 125, Phoenix, AZ 85023-4226 | 2020-07-23 |
| 1730359084 | Advanced Spine and Pain LLC | Anesthesiology | 2 8th St, Hammonton, NJ 08037-3347 | 2008-03-03 |
| Street Address |
4566 E INVERNESS AVE STE 205 |
| City | MESA |
| State | AZ |
| Zip Code | 85206-4634 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720693062 | Inner Balance Counseling LLC | Counselor | 4111 E Auto Valley Drive, Suite 101, Mesa, AZ 85206 | 2020-09-14 |
| 1356978969 | Choices 4 Change Counseling and Coaching LLC | Social Worker | 3707 E Southern Ave., Suite 2027, Mesa, AZ 85206 | 2020-03-24 |
| 1023651288 | Jason Mcclure | Hearing Instrument Specialist | 5540 E Broadway Rd., Mesa, AZ 85206 | 2019-10-21 |
| 1255995361 | Vhs of Phoenix Inc | General Acute Care Hospital | 5750 E. Baseline Rd., Mesa, AZ 85206 | 2019-04-24 |
| 1932682184 | Adam Fishel Frose | Psychologist | 4555 E Inverness Ave Ste 112, Mesa, AZ 85206 | 2018-09-13 |
| 1376024737 | Robyn Kathleen Hall | Psychologist | 4115 East Valley Auto Drive, Suite 208, Mesa, AZ 85206 | 2018-08-23 |
| 1790264984 | Perspective Health, LLC | Clinic/Center | 1959 S. Power Rd, Suite 103, #206, Mesa, AZ 85206 | 2018-08-09 |
| 1033605159 | Rebecca Ann Maro | Nurse Practitioner | 6750 E Baywood Ave Ste 502, Mesa, AZ 85206 | 2018-07-02 |
| 1982195624 | Spark Performance and Physiotherapy | Clinic/Center | 6056 East Basline Road, Suite 147, Mesa, AZ 85206 | 2018-05-29 |
| 1336645993 | Ashley Wright | Audiologist-Hearing Aid Fitter | 1423 S Higley Rd Ste 119, Mesa, AZ 85206 | 2018-04-03 |
| Find all providers in zip 85206 | ||||
| Taxonomy Code | 2081P2900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Physical Medicine & Rehabilitation |
| Specialization | Pain Medicine |
| A physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source changed] Additional Resources: American Board of Physical Medicine and Rehabilitation, 2007. http://www.abpmr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Physical Medicine and Rehabilitation. A subspecialty certificate was approved by the ABMS in 1999. ACGME Accredited Residency Program Requirements: Proposal under development. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134785967 | Dylan Irish | Physical Medicine & Rehabilitation | 5233 E Southern Ave Ste 104, Mesa, AZ 85206-3628 | 2019-05-16 |
| 1437437605 | M S C Holding Group LLC | Physical Medicine & Rehabilitation | 1640 S Stapley Dr, Suite 245, Mesa, AZ 85204-6667 | 2011-07-22 |
| 1568643047 | Premier Physician's Group, Pllc | Physical Medicine & Rehabilitation | 4540 E Baseline Rd Ste 105, Mesa, AZ 85206-4616 | 2007-11-26 |
| 1588610646 | Joseph R Gottesman, LLC | Physical Medicine & Rehabilitation | 2023 W Guadalupe Rd, Ste 11-181, Mesa, AZ 85202-7371 | 2006-05-26 |
| 1053939066 | Ace Medical Group LLC | Physical Medicine & Rehabilitation | 5233 E Southern Ave Ste 104, Mesa, AZ 85206-3628 | 2020-07-07 |
| 1700404712 | Apple Medical Group LLC | Physical Medicine & Rehabilitation | 5233 E Southern Ave Ste 103, Mesa, AZ 85206-3628 | 2020-07-07 |
| 1548804800 | Mesa Regen Group, LLC | Physical Medicine & Rehabilitation | 5233 E Southern Ave Ste 103, Mesa, AZ 85206-3628 | 2019-10-30 |
| 1699122960 | Oasis Pm&r Services, Pllc | Physical Medicine & Rehabilitation | 5652 E Baseline Rd, Mesa, AZ 85206-4713 | 2016-05-17 |
| 1730505017 | Pioneer Sports and Spine Pllc | Physical Medicine & Rehabilitation | 5652 E Baseline Rd, Mesa, AZ 85206-4713 | 2014-03-11 |
| 1740601962 | Calgary Medical LLC | Physical Medicine & Rehabilitation | 4540 E Baseline Rd, Suite 105, Mesa, AZ 85206-4613 | 2013-12-16 |
| Find all providers in MESA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.