PACIFIC SPORTS AND INTERVENTIONAL SPINE, LLC (NPI# 1881186336) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881186336 |
| Entity Type | Organization |
| Organization Name | PACIFIC SPORTS AND INTERVENTIONAL SPINE, LLC |
| Other Organization Name | PACIFIC SPORTS AND SPINE |
| Practice Address |
74b Centennial Loop Ste 100 Eugene OR 97401-7919 |
| Practice Telephone | 5416863791 |
| Practice Fax Number | 5416863795 |
| Mailing Telephone | 5416863791 |
| Mailing Fax Number | 5416863795 |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2018-11-29 |
| Authorized Official Name | SAM DERRICK (ADMINISTRATOR) |
| Authorized Official Telephone | 5416863791 |
| Authorized Official Credential | MHA, CMPE |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
MD28629 | OR | Allopathic & Osteopathic Physicians |
| N | 363A00000X | Physician Assistant | PA00800 | OR | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | PA00420 | OR | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | PA152998 | OR | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
MD27887 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 500624453 | 05 | |
| OR | 244117 | 05 | |
| OR | 500608609 | 05 | |
| OR | 500632183 | 05 | |
| OR | 500604467 | 05 |
| Other Name | Type Code |
|---|---|
| Pacific Sports and Spine | Doing Business As Name - Organization |
| Street Address |
74B CENTENNIAL LOOP STE 100 |
| City | EUGENE |
| State | OR |
| Zip Code | 97401-7919 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831125616 | Joseph S Dunn | Pain Medicine | 74b Centennial Loop Ste 100, Eugene, OR 97401-7919 | 2006-06-24 |
| 1023594801 | Neurospine Group | Neurological Surgery | 74b Centennial Loop Ste 100, Eugene, OR 97401-7919 | 2018-07-16 |
| 1730575119 | Rishi Vora | Physical Medicine & Rehabilitation | 74b Centennial Loop Ste 100, Eugene, OR 97401 | 2015-04-12 |
| 1902000599 | Carmina Flores Angeles | Neurological Surgery | 74b Centennial Loop Ste 100, Eugene, OR 97401-7919 | 2007-06-14 |
| 1982612446 | Stephen G. Giles | Physician Assistant | 74b Centennial Loop Ste 100, Eugene, OR 97401 | 2006-08-03 |
| 1679594089 | Dana Kathryn Rubin | Physician Assistant | 74b Centennial Loop Ste 100, Eugene, OR 97401-7919 | 2006-07-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427681709 | Sarah Voigt | Counselor | 2149 Centennial Plaza Suite #4, Eugene, OR 97401 | 2020-02-14 |
| 1801426242 | Therapeutic Associates, Inc. | Physical Therapist | 760 Charnelton St., Suite 760, Eugene, OR 97401 | 2020-01-24 |
| 1225676232 | Aaron James Barber | Massage Therapist | 1375 Pearl St, Eugene, Or 97401, Eugene, OR 97401 | 2019-12-20 |
| 1851957047 | Altru Home Care LLC | Nursing Care | 1345 Olive St., Eugene, OR 97401 | 2019-05-14 |
| 1881155208 | Herron Jordanna Spence | Speech-Language Pathologist | 385 West 2nd Ave., Eugene, OR 97401 | 2019-03-28 |
| 1750855094 | Brandon Marshall | Counselor | 1158 High St Ste 202, Eugene, OR 97401 | 2019-01-21 |
| 1881172591 | Kayla Nicole O'brien | Nurse Practitioner | Country Club In Eugene, 520 Country Club Road, Eugene, OR 97401 | 2018-08-03 |
| 1962992180 | Shannon Jensen Smyth | Counselor | Va Eugene Downtown Clinic, 211 E. 7th Ave, Eugene, OR 97401 | 2018-05-14 |
| 1902305956 | Christine Noel Gray | Peer Specialist | 499 W. 4th Ave, Eugene, OR 97401 | 2018-02-06 |
| 1821507344 | Anjuli Chitkara | Psychologist | 1679 Willamette Street, Eugene, OR 97401 | 2017-09-27 |
| Find all providers in zip 97401 | ||||
| Taxonomy Code | 208VP0014X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pain Medicine |
| Specialization | Interventional Pain Medicine |
| Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831125616 | Joseph S Dunn | Pain Medicine | 74b Centennial Loop Ste 100, Eugene, OR 97401-7919 | 2006-06-24 |
| 1235319666 | Michael Karasek, Md,pc | Pain Medicine | 689 E 19th Ave, Eugene, OR 97401-4304 | 2007-11-14 |
| 1457496705 | Gregory Anthony Moore | Pain Medicine | 74b Centennial Loop, Suite 100, Eugene, OR 97401-7918 | 2007-02-21 |
| 1366500589 | Pain Consultants of Oregon PC | Pain Medicine | 360 S Garden Way Ste 101, Eugene, OR 97401-8034 | 2006-12-04 |
| 1184649303 | Donna M Morgan | Pain Medicine | 1125 Darlene Ln, Suite 200, Eugene, OR 97401-1601 | 2006-07-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164942611 | Mid-valley Healthcare, Inc. | Pain Medicine | 5234 Sw Philomath Blvd Ste C, Corvallis, OR 97333-1042 | 2017-06-26 |
| 1093269995 | Center for Regenerative Orthopedic Medicine, PC | Pain Medicine | 786 State St, Medford, OR 97504-8441 | 2016-08-09 |
| 1649420548 | Pacific Pain Management PC | Pain Medicine | 6542 Se Lake Rd Ste 202, Milwaukie, OR 97222-2245 | 2008-09-26 |
| 1336265107 | Laura M Scobie | Pain Medicine | 1010 Tenth St, Hood River, OR 97031 | 2007-03-22 |
| 1427188309 | Patrick Rask | Pain Medicine | 2364 Main St, Suite A, Philomath, OR 97370-9488 | 2007-03-07 |
| 1912940396 | Mid-valley Healthcare Inc | Pain Medicine | 100 Mullins Dr Ste C, Lebanon, OR 97355-3982 | 2006-06-14 |
| 1063418333 | Vladimir B. Fiks | Pain Medicine | 10305 Sw Park Way, Ste 300, Portland, OR 97225-5033 | 2005-06-22 |
| 1861900516 | Cornell Pain Clinic LLC | Pain Medicine | 15455 Nw Greenbrier Pkwy Ste 130, Beaverton, OR 97006 | 2018-01-16 |
| 1578077954 | Liberty Spine & Pain Center, P.C. | Pain Medicine | 350 Miller St Se, Salem, OR 97302-4272 | 2017-11-21 |
| 1003362922 | Mid-valley Healthcare, Inc. | Pain Medicine | 100 Mullins Dr Ste C1, Lebanon, OR 97355-2868 | 2016-08-31 |
| Find all providers with the same taxonomy | ||||
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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.