NORTHEAST ARKANSAS PAIN MEDICINE
NPI 1235300765
Pain Medicine - Interventional Pain Medicine in Jonesboro, AR
About Northeast Arkansas Pain Medicine NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
NORTHEAST ARKANSAS PAIN MEDICINE (NPI 1235300765) is a healthcare organization registered as an interventional pain medicine in Jonesboro, Arkansas and active in the NPI registry since March 2008. The organization holds a CLIA Certificate of Compliance certificate valid through April 10, 2027 and lists Monica R Formon, Office Manager, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 3
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Northeast Arkansas Pain Medicine is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Northeast Arkansas Pain Medicine, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 2 within 10 miles. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
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 Compliance 04D2013619
Northeast Arkansas Pain Medicine, LLC · Jonesboro, ARFrequently 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 Northeast Arkansas Pain Medicine's NPI number?
The NPI number for Northeast Arkansas Pain Medicine is 1235300765. It was assigned to this organization in the NPPES registry on March 12, 2008.
Where is Northeast Arkansas Pain Medicine located?
Northeast Arkansas Pain Medicine is located at 505 E Matthews Ave Suite 103, Jonesboro, AR 72401. The listed phone number is (870) 972-0411.
What is Northeast Arkansas Pain Medicine's specialty?
The primary specialty registered for this NPI is Pain Medicine, specializing in Interventional Pain Medicine, with taxonomy code 208VP0014X.
Is Northeast Arkansas Pain Medicine enrolled in Medicare?
Yes. Northeast Arkansas Pain Medicine is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Northeast Arkansas Pain Medicine?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Northeast Arkansas Pain Medicine, in Interventional Pain Management 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. Of these, 1 practice at this address and 2 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Northeast Arkansas Pain Medicine hold a CLIA laboratory certificate?
Yes. A Certificate of Compliance (number 04D2013619) is associated with this NPI, valid through April 10, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Northeast Arkansas Pain Medicine was last updated on December 15, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.
# Northeast Arkansas Pain Medicine · NPI 1235300765
Interventional Pain Medicine organization in Jonesboro, Arkansas. Organization record, active in the CMS NPPES registry since March 12, 2008.
## Identity
- **NPI:** 1235300765 (Entity type: Organization)
- **Enumerated:** March 12, 2008
- **Primary specialty:** Pain Medicine - Interventional Pain Medicine · taxonomy 208VP0014X
- **Organization subpart:** No
- **Authorized official:** Monica Formon, OFFICE MANAGER
## Practice location
- **Address:** 505 E MATTHEWS AVE, SUITE 103, Jonesboro, AR 72401-3144
- **Phone:** (870) 972-0411 · **Fax:** (870) 933-8011
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Interventional Pain Management (1), Nurse Practitioner (1); 1 practice at this address and 2 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** December 15, 2009
- **Other identifiers:** Medicare PIN 5K398 (AR); Other 5K398 (AR); Medicaid 143853002 (AR)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1235300765) · Data from the CMS NPPES public registry.