BROKEN ARROW PAIN SPECIALIST, LLC
NPI 1104549427
Pain Medicine - Pain Medicine in Tahlequah, OK

Q: What is Broken Arrow Pain Specialist, LLC's NPI number?

The NPI number for Broken Arrow Pain Specialist, LLC is 1104549427. It was assigned to this organization in the NPPES registry on September 21, 2022. The provider is doing business as Oklahoma Pain Specialist.

Q: What is Broken Arrow Pain Specialist, LLC's specialty?

The primary specialty registered for this NPI is Pain Medicine with taxonomy code 208VP0000X.

Active since September 21, 2022

2028 MAHANEY AVE, TAHLEQUAH, OK 74464(918) 992-6050(833) 763-2349 Get Directions Write a Review

NPPES record last updated: July 22, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jul 22, 2026, Jul 14, 2026, Sep 21, 2022 (3 updates tracked since 2022).

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About Broken Arrow Pain Specialist, Llc NPPES

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

BROKEN ARROW PAIN SPECIALIST, LLC (NPI 1104549427), doing business as Oklahoma Pain Specialist, is a healthcare organization registered as a pain medicine in Tahlequah, Oklahoma and active in the NPI registry since September 2022. The organization lists Ian Kelley, Sole Member, as its authorized official.

NPPES Registry Identity

NPI1104549427

Entity TypeOrganization

Primary Taxonomy208VP0000X

Legal Business NameBROKEN ARROW PAIN SPECIALIST, LLC

Location Address2028 MAHANEY AVETahlequah, OK 74464-5783

Mailing Address2028 Mahaney AveTahlequah, OK 74464-5783 · (918) 992-6050 · Fax (833) 763-2349

Phone(918) 992-6050

Fax(833) 763-2349

Organization SubpartNo

Authorized OfficialIan KelleySole Member · (918) 633-0447

Enumeration DateSeptember 21, 2022

Last NPPES UpdateJuly 22, 20263 updates tracked since enumeration

NPPES CertifiedJuly 22, 2026

✔ NPI 1104549427 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPain Medicine · Pain MedicineAllopathic & Osteopathic Physicians

Taxonomy Code208VP0000X

Definition

Pain Medicine is a primary medical specialty based on a distinct body of knowledge and a well-defined scope of clinical practice that is founded on science, research and education. It is concerned with the study of pain, the prevention of pain, and the evaluation, treatment, and rehabilitation of persons in pain. A comprehensive evaluation incorporates the physical, psychological, cognitive and socio-cultural contributions to pain. The treatment protocol may include pharmacological, invasive, behavioral, cognitive, rehabilitative and complementary strategies provided in a concurrent focused and patient specific manner. The pain medicine physician often serves the patient as a frontline physician regarding their pain, but also may serve as a consultant to other physicians, direct an interdisciplinary/multidisciplinary treatment team, conduct research, or advocate for the patient's pain care with public and private agencies. The Pain Medicine physician may work in variety of settings including office, clinic, hospital, university, or governmental/public agencies.

2028 MAHANEY AVE, Tahlequah, OK 74464

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Other Names 1

Doing Business AsOklahoma Pain Specialist

Other Identifiers 1

Medicaid200121490AOK

Group Practice 1

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 Blue Cross and Blue Shield of Oklahoma.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Broken Arrow Pain Specialist, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 3 clinicians reassign Medicare billing to Broken Arrow Pain Specialist, LLC, which bills Medicare for the services they deliver. They are listed nearest first.

Clinicians, nearest first (3)

Crystal Reneau, APRN-CNP

Nurse Practitioner

NPI 1639942105

1129 S ASPEN AVE
Broken Arrow, OK 74012

(539) 367-1253

✔ PECOS✔ Accepts Medicare48 mi

Jodi Wiley, DO

General Practice

NPI 1851974653

6717 S YALE AVE STE 210
Tulsa, OK 74136

(918) 675-0068

✔ PECOS✔ Accepts Medicare54 mi

Michelle Wells, D.O.

Family Practice

NPI 1699989509

1111 S SAINT LOUIS AVE
Tulsa, OK 74120

(918) 619-4600

✔ PECOS✔ Accepts Medicare57 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Broken Arrow Pain Specialist, LLC's NPI number?

The NPI number for Broken Arrow Pain Specialist, LLC is 1104549427. It was assigned to this organization in the NPPES registry on September 21, 2022. The provider is doing business as Oklahoma Pain Specialist.

Where is Broken Arrow Pain Specialist, LLC located?

Broken Arrow Pain Specialist, LLC is located at 2028 Mahaney Ave, Tahlequah, OK 74464. The listed phone number is (918) 992-6050.

What is Broken Arrow Pain Specialist, LLC's specialty?

The primary specialty registered for this NPI is Pain Medicine with taxonomy code 208VP0000X.

Is Broken Arrow Pain Specialist, LLC enrolled in Medicare?

Yes. Broken Arrow Pain Specialist, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Broken Arrow Pain Specialist, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to Broken Arrow Pain Specialist, LLC, in Family Practice, General Practice and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Broken Arrow Pain Specialist, LLC accept?

Health plans from Blue Cross and Blue Shield of Oklahoma list Broken Arrow Pain Specialist, 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 Broken Arrow Pain Specialist, LLC was last updated on July 22, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months 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.