NPIMap

Organization Active NPI

Riverside Spine & Pain Physicians, LLC

  • Specialist
  • Jacksonville, FL
National Provider Identifier
1639208648
Registry record updated Jul 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
ME83572 Issued in FL
Legal business name
RIVERSIDE SPINE & PAIN PHYSICIANS, LLC
Practice address
7207 Golden Wings Rd Ste 100
Jacksonville, FL 32244-3324
Phone
(904) 389-1010
Fax
(904) 389-1082
NPI assigned
Mar 5, 2007
Last updated
Jul 14, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2022

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

Authorized official

Name
Dr. Jennifer B Baldock
Title
Officer and Authorized Official
Phone
(615) 234-5900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X ME83572 FL Primary

Addresses

Primary practice location

7207 Golden Wings Rd Ste 100
Jacksonville, FL 32244-3324

Mailing address

7207 Golden Wings Rd Ste 100
Jacksonville, FL 32244-3324
Phone (904) 389-1010

Other identifiers 2

IdentifierTypeStateIssuer
2947648OtherFLAETNA
34167OtherFLBLUE CROSS BLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040204000868 FL Part B Supplier - Clinic/Group Practice 9931092814 Receives reassigned benefits from 13 practitioners
Practice locations: Jacksonville, FL

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

10278 San Jose Blvd 2
Jacksonville, FL 32257

4339 Roosevelt Blvd
Jacksonville, FL 32210
Phone (904) 291-8785

6195 Lake Gray Blvd
Ste 4
Jacksonville, FL 32244

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657756800000",
    "number": "1639208648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7207 GOLDEN WINGS RD STE 100",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322443324",
            "telephone_number": "904-389-1010",
            "fax_number": "904-389-1082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7207 GOLDEN WINGS RD STE 100",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322443324",
            "telephone_number": "904-389-1010",
            "fax_number": "904-389-1082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE SPINE & PAIN PHYSICIANS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2022-07-14",
        "certification_date": "2022-07-14",
        "status": "A",
        "authorized_official_last_name": "BALDOCK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OFFICER AND AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "615-234-5900",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME83572",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2947648",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "34167",
            "state": "FL"
        }
    ],
    "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 Jul 14, 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.