NPIMap

Organization Active NPI

Formoso Pain Specialists, PA

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Jacksonville, FL
National Provider Identifier
1487270351
Registry record updated Apr 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
Legal business name
FORMOSO PAIN SPECIALISTS, PA
Practice address
11555 Central Pkwy Ste 304
Jacksonville, FL 32224-2694
Phone
(904) 201-3111
Fax
(904) 201-3095
NPI assigned
Jun 17, 2020
Last updated
Apr 20, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2022

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

Authorized official

Name
Dr. Ferdinand Formoso, DONPI 1801000161
Title
Owner
Phone
(904) 588-2393

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X Primary
Interventional Pain Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208VP0014X

Addresses

Primary practice location

11555 Central Pkwy Ste 304
Jacksonville, FL 32224-2694

Mailing address

11555 Central Pkwy Ste 304
Jacksonville, FL 32224-2694
Phone (904) 650-2963

Other practice location 1

1361 13th Ave S Ste 250
Jacksonville Beach, FL 32250-3238
Phone (904) 201-3111

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200714002283 FL Part B Supplier - Clinic/Group Practice 3072936772 Receives reassigned benefits from 3 practitioners
Practice locations: Jacksonville, FL; Jacksonville Beach, FL

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Locations

11555 Central Pkwy
Jacksonville, FL 32224
Phone (904) 885-2785

11555 Central Pkwy
Ste 304
Jacksonville, FL 32224
Phone (904) 201-3111

5913 Normandy Blvd
Ste 1
Jacksonville, FL 32205
Phone (904) 378-2880

Practitioners & affiliated clinicians

Practitioners 10

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": "1592352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650412800000",
    "number": "1487270351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11555 CENTRAL PKWY STE 304",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322242694",
            "telephone_number": "904-650-2963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11555 CENTRAL PKWY STE 304",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322242694",
            "telephone_number": "904-201-3111",
            "fax_number": "904-201-3095"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1361 13th Ave S Ste 250",
            "address_purpose": "LOCATION",
            "city": "Jacksonville Beach",
            "state": "FL",
            "postal_code": "322503238",
            "country_code": "US",
            "telephone_number": "904-201-3111",
            "fax_number": "904-201-3095",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FORMOSO PAIN SPECIALISTS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-17",
        "last_updated": "2022-04-20",
        "certification_date": "2022-04-20",
        "status": "A",
        "authorized_official_last_name": "FORMOSO",
        "authorized_official_first_name": "FERDINAND",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-588-2393",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "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 Apr 20, 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.