Interventional Spine and Pain Institute LLC

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

Legal business name

INTERVENTIONAL SPINE AND PAIN INSTITUTE LLC

Practice address

777 37TH St Ste C101
Vero Beach, FL 32960-7301

Phone

(908) 303-8044

NPI assigned

Jan 7, 2022

Organization subpart

No

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

Authorized official

Name

Phaedra L Shudra

Title

Credentialing & Contracting Spec

Phone

(813) 785-4861

Specialties & licenses 6

Addresses

Medicare fee-for-service enrollment

Enrolled in FL2 enrollments

Enrollment records 2

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Interventional Spine and Pain Institute LLC

  • Interventional Pain Medicine Physician
  • Melbourne, FL
  • NPI 1093695504

  2365836582

  Same PAC ID

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/DJDGCD

Practitioners 7

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

• Melissa A. Burgos-Martir, MD

  • Physical Medicine & Rehabilitation Physician
  • Melbourne, FL
  • NPI 1821390584
  Medicare reassignment Care Compare group NPD
• Michael Franklin Esposito, M.D.

  • Interventional Pain Medicine Physician
  • Vero Beach, FL
  • NPI 1043521198

  Anesthesiology

  Medicare reassignment Care Compare group NPD
• Paul Dominic Lopreato, P.A.

  • Physician Assistant
  • Palm Bay, FL
  • NPI 1447499082
  Medicare reassignment Care Compare group NPD
• Christopher Weeden, MD

  • Interventional Pain Medicine Physician
  • Vero Beach, FL
  • NPI 1538628482
  Medicare reassignment Care Compare group NPD
• John Paul Welch, ANP-BC, RN

  • Nurse Practitioner
  • Melbourne, FL
  • NPI 1912228495
  Medicare reassignment Care Compare group NPD
• Anastasia Seeram, PA-C

  • Physician Assistant
  • Vero Beach, FL
  • NPI 1699968602
  Medicare reassignment NPD
• Nathaniel Soter, DNP

  • Nurse Practitioner
  • Vero Beach, FL
  • NPI 1184500456
  Medicare reassignment NPD

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

{
    "created_epoch": "1641513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758844800000",
    "number": "1134880487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 37TH ST STE C101",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329607301",
            "telephone_number": "772-360-1997",
            "fax_number": "772-492-3541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 37TH ST STE C101",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329607301",
            "telephone_number": "908-303-8044"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6559 N Wickham Rd",
            "address_purpose": "LOCATION",
            "city": "Melbourne",
            "state": "FL",
            "postal_code": "329402052",
            "country_code": "US",
            "telephone_number": "772-360-1997",
            "fax_number": "772-492-3541",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5200 Babcock St NE Ste 111",
            "address_purpose": "LOCATION",
            "city": "Palm Bay",
            "state": "FL",
            "postal_code": "329054639",
            "country_code": "US",
            "telephone_number": "772-360-1997",
            "fax_number": "772-492-3541",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INTERVENTIONAL SPINE AND PAIN INSTITUTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-07",
        "last_updated": "2025-09-26",
        "certification_date": "2025-09-26",
        "status": "A",
        "authorized_official_last_name": "SHUDRA",
        "authorized_official_first_name": "PHAEDRA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALING & CONTRACTING SPEC",
        "authorized_official_telephone_number": "813-785-4861"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Integrated Rehabilitation Adult and Pediatrics LLC
• Integrity - Dixie Oak Manor, LLC
• Intergold LLC
• Intermedik LLC
• Interventional Pain Management of the Treasure Coast PA
• Genevieve Theresa Introcaso, LCSW
• Suzanne Victoria Ions, BS
• Ir Health Centers LLC
• Irecovery, LLC
• Irene Rahman-Garcia MD PA

• Interventional Pain Medicine Physician in Vero Beach, FL
• Providers in Vero Beach, FL by specialty
• Interventional Pain Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.