FX Spine and Performance Center, LLC

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

Legal business name

FX SPINE AND PERFORMANCE CENTER, LLC

Practice address

106 SRP Dr Ste B
Evans, GA 30809-4358

Phone

(706) 842-6800

Fax

(706) 842-6780

NPI assigned

Jul 24, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Nicholas Allan Deangelo, DONPI 1386604650

Title

President

Phone

(717) 557-5926

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

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://api.platform.athenahealth.com/22189/brand/1/csg/1/fhir/r4

Practitioners 2

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

• Nicholas A. Deangelo, D.O.

  • Anesthesiology Physician
  • Evans, GA
  • NPI 1386604650

  GA

  Medicare reassignment NPD Authorized official
• Jessica Anne Parker, NP

  • Family Nurse Practitioner
  • Atlanta, GA
  • NPI 1114636859

  GA

  Medicare reassignment NPD

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

{
    "created_epoch": "1595548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606953600000",
    "number": "1558970640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 KESTREL DR",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308090328",
            "telephone_number": "717-557-5926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 SRP DR STE B",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308094358",
            "telephone_number": "706-842-6800",
            "fax_number": "706-842-6780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FX SPINE AND PERFORMANCE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-24",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A",
        "authorized_official_last_name": "DEANGELO",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "ALLAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "717-557-5926",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Regina Frazier, OTR/L
• Sincerity Freeman, RBT
• Luke Frey, RN
• Jessica Fritz, LMHC
• Karolina Funderburk, RBT
• G. David Volpitto, MD PC
• Saralyn Gamble
• Robert Clayton Gambrell, MD
• Haley Gasaway, RBT
• Gastroenterology Consultants of Augusta, PC

• All providers in Evans, GA
• Pain Medicine (Anesthesiology) Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2020; 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.