Premier Spine & Pain Institute – Pain Medicine (Physical Medicine & Rehabilitation) Physician, NPI 1639610389
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Premier Spine & Pain Institute
PO BOX 29037
THORNTON, CO 802290037
Phone: (303) 209-7590
Type: Mailing
Grant Street, Thornton, Adams County, Colorado, United States
THORNTON, CO 802294365
Phone: (303) 209-7590
Fax: (303) 209-7590
Type: Location
9195 Grant St Ste 105
Thornton, CO 802294386
Phone: (303) 844-5000
Type: Location
380 Empire Rd Ste 204
Lafayette, CO 800262677
Phone: (303) 844-5000
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2022-01-21
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2025-09-30 (253 days ago).
Enrollment records
1
Earliest due date
2025-09-30
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20220121000990 | O | Other | CO | 2025-09-30 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 80229)
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