NPIMap

Organization Active NPI

Advanced Spine and Pain Center, P.a.

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Benson, NC
National Provider Identifier
1639317332
Registry record updated Mar 1, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
License
2007-00587 Issued in NC
Legal business name
ADVANCED SPINE AND PAIN CENTER, P.A.
Practice address
1 Medical Dr
Benson, NC 27504-1177
Phone
(919) 894-1740
Fax
(919) 894-2701
NPI assigned
Feb 3, 2009
Last updated
Mar 1, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2014

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

Authorized official

Name
Rachid Idrissi, MDNPI 1174696363
Title
President
Phone
(919) 894-1740

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) Physician 2081P2900X 2007-00587 NC Primary
Pain Medicine Physician 208VP0000X

Addresses

Primary practice location

1 Medical Dr
Benson, NC 27504-1177

Mailing address

PO Box 839
Benson, NC 27504
Phone (919) 894-1740

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090428000600 NC Part B Supplier - Clinic/Group Practice 8527116680 Receives reassigned benefits from 20 practitioners
Practice locations: Benson, NC; Clayton, NC; Fayetteville, NC; Fuquay Varina, NC; Lillington, NC

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

1004 Procure St
#100
Fuquay Varina, NC 27526
Phone (919) 557-6091

742 McKnight Dr
Ste 130
Knightdale, NC 27545
Phone (919) 359-8643

4242 Fayetteville Rd
Lumberton, NC 28358
Phone (910) 321-1012

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1233619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1393632000000",
    "number": "1639317332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 839",
            "city": "BENSON",
            "state": "NC",
            "postal_code": "27504",
            "telephone_number": "919-894-1740",
            "fax_number": "919-894-2701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL DR",
            "city": "BENSON",
            "state": "NC",
            "postal_code": "275041177",
            "telephone_number": "919-894-1740",
            "fax_number": "919-894-2701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED SPINE AND PAIN CENTER, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-03",
        "last_updated": "2014-03-01",
        "status": "A",
        "authorized_official_last_name": "IDRISSI",
        "authorized_official_first_name": "RACHID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "919-894-1740",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "NC",
            "license": "2007-00587",
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Benson, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2014; 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.