NPIMap

Individual provider Active NPI

Pavel Balduyeu, MD

  • Pain Medicine (Anesthesiology) Physician
  • Jacksonville, FL
National Provider Identifier
1659798940
Registry record updated Sep 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
ME135467 Issued in FL
Practice address
2627 Riverside Ave Ste 32204
Jacksonville, FL 32204-4717
Phone
(904) 634-0640
Fax
(904) 634-0203
NPI assigned
Mar 25, 2014
Last updated
Sep 27, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X ME135467 FL Primary

Addresses

Primary practice location

2627 Riverside Ave Ste 32204
Jacksonville, FL 32204-4717

Mailing address

6800 Southpoint Pkwy Ste 300
Jacksonville, FL 32216-8203
Phone (904) 634-0640

Other identifiers 1

IdentifierTypeStateIssuer
LB421OtherFLMEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181228000518 FL Practitioner - AnesthesiologyPractitioner - Pain Management 5092931824 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
AnesthesiologyAlso: Pain Management
Education
Other, 2007
Medicare assignment
May accept Medicare assignment
Group practices
Lake Area Physical Therapy Inc.Group PAC ID 3678604840, 372 clinicians

Practice addresses (Care Compare)

2627 Riverside Ave
FL 3
Jacksonville, FL 32204-4717
Phone (904) 634-0640

PO Box
Suite 1099
Melrose, FL 32666-1099

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.36 of 100Reported as individual
Quality
84.3
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Clinical Practice Association Inc CurrentSince Jan 1, 2019 Accepting new patients
Southeast Orthopedic Specialists, LLC CurrentSince Apr 12, 2021 Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Jan 1, 2019 Accepting new patients
Southeast Orthopedic Specialists, LLC CurrentSince Apr 12, 2021 Accepting new patients
Physicians Group Services PA Past Accepting new patients

Locations

4565 US Highway 17
Ste 200
Fleming Island, FL 32003
Phone (904) 630-0640

1600 SW Archer Rd
Gainesville, FL 32610
Phone (352) 265-0077

2001 SW 13th St
Gainesville, FL 32608
Phone (352) 265-8990

10475 Centurion Pkwy N
Ste 220
Jacksonville, FL 32256
Phone 9046340640 ext. 1014

15255 Max Leggett Pkwy
Ste 5300
Jacksonville, FL 32218
Phone (904) 203-1386

2627 Riverside Ave
Fl 3
Jacksonville, FL 32204
Phone 9046340640 ext. 1014

2627 Riverside Ave
Ste 300
Jacksonville, FL 32204
Phone (904) 634-0460

4268 Oldfield Crossing Dr
Ste 201
Jacksonville, FL 32223
Phone (904) 630-0640

6800 Southpoint Pkwy
Ste 300
Jacksonville, FL 32216

2300 Park Ave
Ste 206
Orange Park, FL 32073
Phone (904) 278-4274

232 Ponte Vedra Park Dr
Ponte Vedra Beach, FL 32082
Phone (904) 285-7546

1690 US Highway 1 S
Ste F
St Augustine Beach, FL 32084
Phone (904) 634-0460

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: pavel.balduyeu.1@22724.direct.athenahealth.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1395705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632700800000",
    "number": "1659798940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6800 SOUTHPOINT PKWY STE 300",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322168203",
            "telephone_number": "904-634-0640",
            "fax_number": "904-634-0203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2627 RIVERSIDE AVE STE 32204",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044717",
            "telephone_number": "904-634-0640",
            "fax_number": "904-634-0203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALDUYEU",
        "first_name": "PAVEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-25",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "FL",
            "license": "ME135467",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "LB421",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.