NPIMap

Organization Active NPI

Regenerative Medicine of North Florida LLC

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Jacksonville, FL
National Provider Identifier
1093331456
Registry record updated Dec 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
Legal business name
REGENERATIVE MEDICINE OF NORTH FLORIDA LLC
Practice address
4540 Southside Blvd Ste 401
Jacksonville, FL 32216-5488
Phone
(321) 323-3618
NPI assigned
Jun 22, 2020
Last updated
Dec 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2023

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

Authorized official

Name
Rafael Foss, DCNPI 1538257472
Title
Owner
Phone
(786) 370-1111

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU
Physical Therapy Clinic/Center 261QP2000X NU
Pain Medicine (Physical Medicine & Rehabilitation) Physician 2081P2900X NU Primary

Addresses

Primary practice location

4540 Southside Blvd Ste 401
Jacksonville, FL 32216-5488

Mailing address

PO Box 24556
Jacksonville, FL 32241-4556
Phone (786) 370-1111

National Provider Directory

National Provider Directory

Locations

4540 Southside Blvd
Ste 401
Jacksonville, FL 32216
Phone (904) 566-9256

Practitioners & affiliated clinicians

Practitioners 4

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": "1592784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702166400000",
    "number": "1093331456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24556",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322414556",
            "telephone_number": "786-370-1111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4540 SOUTHSIDE BLVD STE 401",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322165488",
            "telephone_number": "321-323-3618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGENERATIVE MEDICINE OF NORTH FLORIDA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-22",
        "last_updated": "2023-12-10",
        "certification_date": "2023-12-10",
        "status": "A",
        "authorized_official_last_name": "FOSS",
        "authorized_official_first_name": "RAFAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "786-370-1111",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.