Spine and Sports Regenerative Medicine Institute

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

Legal business name

SPINE AND SPORTS REGENERATIVE MEDICINE INSTITUTE

Practice address

10721 Main St Ste 304
Fairfax, VA 22030-6902

Phone

(703) 349-4205

Fax

(703) 349-4205

NPI assigned

Jul 9, 2024

Organization subpart

No

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

Authorized official

Name

Dr. David Kim, MDNPI 1073530523

Title

Ceo

Phone

(703) 349-4205

Specialties & licenses 2

Addresses

Other names 1

• Spine and Pain Regenerative Medicine Doing business as

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• David Kim, MD

  • Interventional Pain Medicine Physician
  • Fairfax, VA
  • NPI 1073530523

  DC

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1720483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721088000000",
    "number": "1114764107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10721 MAIN ST STE 304",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220306902",
            "telephone_number": "703-349-4205",
            "fax_number": "703-349-4205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10721 MAIN ST STE 304",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220306902",
            "telephone_number": "703-349-4205",
            "fax_number": "703-349-4205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE AND SPORTS REGENERATIVE MEDICINE INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-09",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-16",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "703-349-4205",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spine and Pain Regenerative Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Spine and Pain Regenerative Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christine Spera, DNP, CRNA
• Sophia Anne Spero
• Spexinc Dba Pearle Vision
• Judith Ida Spicer, CRNP
• Spine and Pain Clinic of North America, LLC
• Jeremy George Spinks, M.D.
• David J Spinosa, MD
• Alexander I Spira, M.D.
• Diane Inselburg Spirer
• Shoshana G Spiro, PA-C

• Interventional Pain Medicine Physician in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Interventional Pain Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2024; 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.