Individual provider Active NPI

Vrajlal L Rajyaguru, MD

  • Pain Medicine (Anesthesiology) Physician
  • Kissimmee, FL
National Provider Identifier
1134348014
Registry record updated Jun 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
ME66759 Issued in FL
Practice address
505 W Vine St # 301
Kissimmee, FL 34741-4156
Phone
(407) 935-9404
Fax
(407) 935-9304
NPI assigned
Apr 25, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X ME0066759 FL
Pain Medicine (Anesthesiology) Physician 207LP2900X ME66759 FL Primary

Addresses

Primary practice location

505 W Vine St # 301
Kissimmee, FL 34741-4156

Mailing address

505 W Vine St # 301
Kissimmee, FL 34741-4156
Phone (407) 935-9404

Other identifiers 2

IdentifierTypeStateIssuer
377046000MedicaidFL
593339956OtherFLTAX IID#

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040827000712 FL Practitioner - Interventional Pain ManagementPractitioner - Anesthesiology 4688649205 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional Pain ManagementAlso: Anesthesiology
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Pain Clinic PAGroup PAC ID 5597844795, 2 clinicians

Practice addresses (Care Compare)

505 W Vine St
Suite 301
Kissimmee, FL 34741-4123
Phone (407) 935-9404

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Pain Clinic PA Anesthesiology CurrentSince Aug 15, 2006 Accepting new patients
Advanced Pain Clinic,PA Pain Medicine Past Accepting new patients
Advanced Pain Clinic PA Pain Medicine Past Accepting new patients
Advanced Pain Clinic PA Pain Medicine Past Accepting new patients

Locations

505 W Vine St
Ste 301
Kissimmee, FL 34741
Phone (407) 935-9404

3901 E Colonial Dr
Orlando, FL 32803
Phone (407) 203-5984

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212537600000",
    "number": "1134348014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 W VINE ST # 301",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347414156",
            "telephone_number": "407-935-9404",
            "fax_number": "407-935-9304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 W VINE ST # 301",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347414156",
            "telephone_number": "407-935-9404",
            "fax_number": "407-935-9304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAJYAGURU",
        "first_name": "VRAJLAL",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-25",
        "last_updated": "2008-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "FL",
            "license": "ME0066759",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "FL",
            "license": "ME66759",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "377046000",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX IID#",
            "identifier": "593339956",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kissimmee, FL

Sources for this page

Verify at the official NPI Registry.