Organization Active NPI

Advanced Integrated Pain & Spine Solutions

  • Pain Medicine Physician
  • Clermont, FL
National Provider Identifier
1023763570
Registry record updated Mar 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
Legal business name
ADVANCED INTEGRATED PAIN & SPINE SOLUTIONS
Practice address
1925 Don Wickham Dr
Clermont, FL 34711-1915
Phone
(407) 807-0098
Fax
(407) 530-0864
NPI assigned
Feb 14, 2022
Last updated
Mar 1, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Narendren Narayanasamy, MDNPI 1982800892
Title
Owner
Phone
(407) 807-0098

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208VP0000X Primary

Addresses

Primary practice location

1925 Don Wickham Dr
Clermont, FL 34711-1915

Mailing address

PO Box 607
Minneola, FL 34755-0607
Phone (407) 807-0098

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220520000149 FL Part B Supplier - Clinic/Group Practice 0244617819 Receives reassigned benefits from 1 practitioner
Practice locations: Clermont, FL; Four Corners, FL; Lady Lake, FL

National Provider Directory

National Provider Directory

Locations

17075 Cagan Ridge Blvd
Ste 101
Clermont, FL 34714
Phone (352) 717-4377

108 Park Place Blvd
Ste B
Davenport, FL 33837
Phone (863) 438-5895

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1644796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646092800000",
    "number": "1023763570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 607",
            "city": "MINNEOLA",
            "state": "FL",
            "postal_code": "347550607",
            "telephone_number": "407-807-0098",
            "fax_number": "407-530-0864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1925 DON WICKHAM DR",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347111915",
            "telephone_number": "407-807-0098",
            "fax_number": "407-530-0864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED INTEGRATED PAIN & SPINE SOLUTIONS",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-14",
        "last_updated": "2022-03-01",
        "certification_date": "2022-03-01",
        "status": "A",
        "authorized_official_last_name": "NARAYANASAMY",
        "authorized_official_first_name": "NARENDREN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-807-0098",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clermont, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.