Provider Demographics
NPI:1952466963
Name:PAIN AND REHABILITATIVE CONSULTANTS MEDICAL GROUP
Entity Type:Organization
Organization Name:PAIN AND REHABILITATIVE CONSULTANTS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BABAK
Authorized Official - Middle Name:JAHROMI
Authorized Official - Last Name:JAMASBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-647-5101
Mailing Address - Street 1:1335 STANFORD AVE
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2536
Mailing Address - Country:US
Mailing Address - Phone:510-649-1000
Mailing Address - Fax:510-649-7010
Practice Address - Street 1:1335 STANFORD AVENUE
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-1115
Practice Address - Country:US
Practice Address - Phone:510-649-7000
Practice Address - Fax:510-649-7010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP26222207L00000X, 207LP2900X, 2081P2900X, 2084P2900X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01113ZOtherBLUE SHIELD OF CALIFORNIA
OH=========00OtherUNIVERSITY COMP CARE PIN
CAZZZ20562ZMedicare ID - Type UnspecifiedGROUP PROVIDER NUMBER