TRISTATE MEDICAL SPECIALISTS LLC (NPI# 1356706774) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356706774 |
| Entity Type | Organization |
| Organization Name | TRISTATE MEDICAL SPECIALISTS LLC |
| Other Organization Name | TRISTATE PAIN INSTITUTE |
| Practice Address |
1987 Mcculloch Blvd N Lake Havasu City AZ 86403-5682 |
| Mailing Address |
Po Box 10966 Fort Mohave AZ 86427-0966 |
| Practice Telephone | 9287883333 |
| Practice Fax Number | 9287883555 |
| Mailing Telephone | 9287883333 |
| Mailing Fax Number | 9287883555 |
| Enumeration Date | 2015-12-30 |
| Last Update Date | 2018-09-13 |
| Authorized Official Name | BENJAMIN H VENGER (OWNER/MEMBER MANAGER) |
| Authorized Official Telephone | 9287883333 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208VP0000X |
Pain Medicine Specialization: Pain Medicine |
20605 | AZ | Allopathic & Osteopathic Physicians |
| N | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 363L00000X | Nurse Practitioner | AP3760 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| N | 207LP2900X |
Anesthesiology Specialization: Pain Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 207T00000X | Neurological Surgery | 20605 | AZ | Allopathic & Osteopathic Physicians |
| N | 2081P2900X |
Physical Medicine & Rehabilitation Specialization: Pain Medicine |
Allopathic & Osteopathic Physicians | ||
| Y | 208VP0000X |
Pain Medicine Specialization: Pain Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 079972 | 05 | |
| DOL | 615056800 | 01 |
| Other Name | Type Code |
|---|---|
| TriState Pain Institute | Doing Business As Name - Organization |
| Street Address |
1987 MCCULLOCH BLVD N |
| City | LAKE HAVASU CITY |
| State | AZ |
| Zip Code | 86403-5682 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720181332 | Blue Water Internal Medicine Associates PC | Internal Medicine | 1987 Mcculloch Blvd N, Suite 101, Lake Havasu City, AZ 86403-5682 | 2006-09-07 |
| 1164542353 | Focus Optical, LLC | Non-Pharmacy Dispensing Site | 1987 Mcculloch Blvd N, Suite #108, Lake Havasu City, AZ 86403-5770 | 2007-03-30 |
| 1083702716 | Stephanie Louise Herrick | Nurse Practitioner | 1987 Mcculloch Blvd N, Ste 101, Lake Havasu City, AZ 86403-5682 | 2006-10-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104479039 | Liska's Apothecary Shop, Inc. | Assisted Living Facility | 1840 Mesquite Ave., Ste. E, Lake Havasu City, AZ 86403 | 2019-07-19 |
| 1275033227 | Ayad Costy | Pharmacist | 75 North Lake Havasu City, Lake Havasu City, AZ 86403 | 2018-02-16 |
| 1942727250 | Ideal Health Care, L.L.C. | Prosthetic/Orthotic Supplier | 1675 Mesquite Ave Ste A, Lake Havasu City, AZ 86403 | 2017-08-28 |
| 1063965036 | Cerner Health Connections, Inc | Clinic/Center | 89 Civic Center Blvd, Lake Havasu City, AZ 86403 | 2016-07-26 |
| 1447643358 | Lundin Dental PC | Durable Medical Equipment & Medical Supplies | 1741 Mesquite Avenue Ste B 100, Lake Havasu City, AZ 86403 | 2015-03-17 |
| 1912301425 | Arizona Havasu Bdm Pak LLC | Dentist | 1799 North Kiowa Blvd, Unit 109, Lake Havasu, AZ 86403 | 2014-10-13 |
| 1386047850 | Emily E Vona | Nurse Practitioner | 84 Acoma Blvd N Ste 104, Lake Havasu City, AZ 86403 | 2014-09-29 |
| 1750700589 | Thomas Wennergren | Pharmacist | 25 S Lake Havasu Ave, Lake Havasu City, AZ 86403 | 2014-04-09 |
| 1285997460 | Jamie L Lemire | Pharmacist | 1980 Mcculloch Blvd, Lake Havasu City, AZ 86403 | 2012-06-21 |
| 1053694448 | Goodwill of Northern Arizona | Exclusive Provider Organization | 1990 Mcculloch Blvd North, Lake Havasu City, AZ 86403 | 2011-09-22 |
| Find all providers in zip 86403 | ||||
| Taxonomy Code | 208VP0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pain Medicine |
| Specialization | Pain Medicine |
| Pain Medicine is a primary medical specialty based on a distinct body of knowledge and a well-defined scope of clinical practice that is founded on science, research and education. It is concerned with the study of pain, the prevention of pain, and the evaluation, treatment, and rehabilitation of persons in pain. A comprehensive evaluation incorporates the physical, psychological, cognitive and socio-cultural contributions to pain. The treatment protocol may include pharmacological, invasive, behavioral, cognitive, rehabilitative and complementary strategies provided in a concurrent focused and patient specific manner. The pain medicine physician often serves the patient as a frontline physician regarding their pain, but also may serve as a consultant to other physicians, direct an interdisciplinary/multidisciplinary treatment team, conduct research, or advocate for the patient’s pain care with public and private agencies. The Pain Medicine physician may work in variety of settings including office, clinic, hospital, university, or governmental/public agencies. |
| Notes: Source: American Academy of Pain Medicine, www.painmed.org - Additional Resources:The American Board of Pain Medicine provides Board Certification. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992364665 | Style Therapeutics | Pain Medicine | 10645 N Tatum Blvd # 200-643, Phoenix, AZ 85028-3068 | 2019-06-06 |
| 1497241079 | Saguaro Treatment Center | Pain Medicine | 5533 E. Bell Rd #111, Scottsdale, AZ 85254 | 2018-07-06 |
| 1427574284 | Hang Doan | Pain Medicine | 12640 W Bethany Home Rd, Litchfield Park, AZ 85340-9599 | 2017-08-14 |
| 1962949354 | Waheeda Siddiqui Ahmed | Pain Medicine | 18185 N 83rd Ave Ste 107, Glendale, AZ 85308-0520 | 2017-01-24 |
| 1265885396 | Painmed LLC | Pain Medicine | 7337 E Thomas Rd, Scottsdale, AZ 85251-7215 | 2016-07-13 |
| 1609264837 | Integrative Pain Centres of Prescott | Pain Medicine | 3769 Crossings Drive, Suite B, Integrative Pain Centres of Prescott, Prescott, AZ 86305 | 2014-12-22 |
| 1780943456 | Desert Rose Neurology | Pain Medicine | 2480 E Wilcox Dr, Sierra Vista, AZ 85635-2841 | 2012-05-15 |
| 1356614176 | Allen Family Medicine Pllc | Pain Medicine | 7233 E Baseline Rd, Ste 126, Mesa, AZ 85209-5007 | 2012-02-10 |
| 1467730135 | Jose M. Chavez | Pain Medicine | 1704 W Anklam Rd Ste 108, Tucson, AZ 85745-2656 | 2011-07-29 |
| 1396034625 | Arizona Pain Center LLC | Pain Medicine | 8787 E Mountain View Rd, Unit 1025, Scottsdale, AZ 85258-1452 | 2011-04-07 |
| Find all providers with the same taxonomy | ||||
| City | LAKE HAVASU CITY |
| Zip Code | 86403 |
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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.