Interventional and Functional Pain Center
NPI 1164907804ActiveOrganization· Physical Medicine & Rehabilitation· Cranston, RI
Physical Medicine & Rehabilitation in Cranston, Rhode Island, registered in NPPES in September 2018. The authorized official on file is Juan Carlos Mirt, Office Manager. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1164907804 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Sep 28, 2018 |
| Last updated in NPPES | Jan 22, 2025 |
| Certified by provider | Jan 22, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Medicine & Rehabilitation Primary | 208100000X | — | — |
| Clinic/Center, Physical Therapy | 261QP2000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (RI) |
|---|
Other physiatrists in Cranston
- 1902232358
- 1699686659
- 1295095537
- 1740887256