OrganizationActive
Pain Management Intraoperative Monitoring LLC
NPI 1043756315 · Electrodiagnostic Medicine Physician · Ft Worth, TX
Provider details
- NPI number
- 1043756315
- Entity type
- Organization
- Primary specialty
- Electrodiagnostic Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Gina Sullivan, Billing Manager(214) 269-3875
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Established profile(70/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
9 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
111 Boland St
211
Ft Worth, TX 76107-1263
Phone: (214) 269-3875
Fax: (903) 328-6568
Street-level locationGet directions
Mailing address
111 Boland St
Ft Worth, TX 76107-1263
Registry dates
- Enumerated
- 2017-01-11
- Last updated
- 2017-01-11
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.