Provider Demographics
| NPI: | 1306280177 |
|---|---|
| Name: | COMMONWEALTH PAIN ASSOCIATES, PLLC |
| Entity type: | Organization |
| Organization Name: | COMMONWEALTH PAIN ASSOCIATES, PLLC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRESIDENT |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | JASON |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | LEWIS |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MD |
| Authorized Official - Phone: | 502-855-7200 |
| Mailing Address - Street 1: | PO BOX 21890 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | BELFAST |
| Mailing Address - State: | ME |
| Mailing Address - Zip Code: | 04915-4115 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 502-907-0356 |
| Mailing Address - Fax: | 502-919-9780 |
| Practice Address - Street 1: | 120 EXECUTIVE PARK |
| Practice Address - Street 2: | |
| Practice Address - City: | LOUISVILLE |
| Practice Address - State: | KY |
| Practice Address - Zip Code: | 40207 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 502-855-7200 |
| Practice Address - Fax: | 502-855-7201 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2013-04-24 |
| Last Update Date: | 2025-06-25 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 208VP0014X | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | Group - Single Specialty |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
| No | 207LP2900X | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | Group - Multi-Specialty |
| No | 208VP0000X | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | Group - Multi-Specialty |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
| No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Multi-Specialty |
| No | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| KY | 7100349390 | Medicaid | |
| KY | 7100488260 | Medicaid | |
| IN | 201287400B | Medicaid | |
| IN | 300012363 | Medicaid | |
| IN | 300026415 | Medicaid | |
| IN | 300027005 | Medicaid | |
| IN | 300073973 | Medicaid | |
| KY | 7100607850 | Medicaid | |
| IN | 300014938 | Medicaid | |
| IN | 201287400A | Medicaid | |
| KY | 7100270310 | Medicaid | |
| IL | 1306280177 | Medicaid | |
| IN | 201287400E | Medicaid | |
| IN | 300026044 | Medicaid | |
| IN | 201287400C | Medicaid | |
| IN | 300061140 | Medicaid | |
| OH | 0300626 | Medicaid | |
| IN | 300009547 | Medicaid | |
| IN | 300014863 | Medicaid | |
| IN | 300050981 | Medicaid | |
| KY | 7100318140 | Medicaid | |
| TN | Q091113 | Medicaid |
