SOUTHERN INTERVENTIONAL PAIN CENTER LLC
NPI 1063971596
Pain Medicine - Interventional Pain Medicine in Lake City, FL

Q: What is Southern Interventional Pain Center LLC's specialty?

The primary specialty registered for this NPI is Pain Medicine, specializing in Interventional Pain Medicine, with taxonomy code 208VP0014X.

Active since March 14, 2019CLIA Certified · 2 labs

619 SW BAYA DR STE 102, LAKE CITY, FL 32025(386) 361-3400(855) 313-1262 Get Directions Write a Review

NPPES record last updated: January 31, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jan 31, 2020, Mar 14, 2019 (2 updates tracked since 2019).

On this page

About Southern Interventional Pain Center Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHERN INTERVENTIONAL PAIN CENTER LLC (NPI 1063971596) is a healthcare organization registered as an interventional pain medicine in Lake City, Florida and active in the NPI registry since March 2019. The organization holds 2 active CLIA laboratory certificates and lists Maximilian Shahryar Shokat, Managing Member, as its authorized official.

NPPES Registry Identity

NPI1063971596

Entity TypeOrganization

Primary Taxonomy208VP0014X

Legal Business NameSOUTHERN INTERVENTIONAL PAIN CENTER LLC

Location Address619 SW BAYA DR STE 102Lake City, FL 32025-4204

Mailing Address615 S Hansell StThomasville, GA 31792-5556 · (229) 226-2234 · Fax (229) 226-2237

Phone(386) 361-3400

Fax(855) 313-1262

Organization SubpartYes

Authorized OfficialMaximilian Shahryar ShokatManaging Member · (229) 226-2234

Enumeration DateMarch 14, 2019

Last NPPES UpdateJanuary 31, 20202 updates tracked since enumeration

✔ NPI 1063971596 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPain Medicine · Interventional Pain MedicineAllopathic & Osteopathic Physicians

Taxonomy Code208VP0014X

Definition

Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment.

Also ListedPsychiatry & Neurology · NeurologyTaxonomy 2084N0400X

619 SW BAYA DR STE 102, Lake City, FL 32025

Open in Google Maps ↗

Group Practice 2

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Capital Health Plan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and revalidation status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Southern Interventional Pain Center Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by December 31, 2026

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date

StateFloridaEnrollment IDO20190322001312DME · Physician - Physical and RehabilitationDue dateDecember 31, 2026

Source: CMS Revalidation Due Date List, October 2026 release.

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D2171446

Southern Interventional Pain Center · Lake City, FL

Active · expires Aug 29, 2027

CLIA Number10D2171446

Laboratory TypePhysician Office

Certificate Effective DateAugust 30, 2025

Certificate Expiration DateAugust 29, 2027

Laboratory DirectorKaren D. Giddens

Laboratory Phone(386) 361-3400

Laboratory LocationSouthern Interventional Pain Center619 SW Baya Dr Ste 102, Lake City, FL 32025

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Certificate of Compliance 11D2028072

Southern Interventional Pain Center · Thomasville, GA

Active · expires Jan 28, 2027

CLIA Number11D2028072

Laboratory TypePhysician Office

Certificate Effective DateJanuary 29, 2025

Certificate Expiration DateJanuary 28, 2027

Laboratory DirectorDr. Max Shokat

Laboratory Phone(229) 226-2234

Laboratory LocationSouthern Interventional Pain Center615 South Hansell Street, Thomasville, GA 31792

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southern Interventional Pain Center LLC's NPI number?

The NPI number for Southern Interventional Pain Center LLC is 1063971596. It was assigned to this organization in the NPPES registry on March 14, 2019.

Where is Southern Interventional Pain Center LLC located?

Southern Interventional Pain Center LLC is located at 619 SW Baya Dr Ste 102, Lake City, FL 32025. The listed phone number is (386) 361-3400.

What is Southern Interventional Pain Center LLC's specialty?

The primary specialty registered for this NPI is Pain Medicine, specializing in Interventional Pain Medicine, with taxonomy code 208VP0014X.

Is Southern Interventional Pain Center LLC enrolled in Medicare?

Yes. Southern Interventional Pain Center LLC is registered in the Medicare PECOS enrollment system.

When is Southern Interventional Pain Center LLC's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare DME enrollment for this organization (Florida, Physician - Physical, Rehabilitation) is due for revalidation by December 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

Does Southern Interventional Pain Center LLC hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Southern Interventional Pain Center LLC accept?

Health plans from Capital Health Plan list Southern Interventional Pain Center LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Southern Interventional Pain Center LLC was last updated on January 31, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.