NPIMap

Individual provider Active NPI

Darrell George Vydra, DO

  • Pain Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1689945495
Registry record updated Jan 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
License
OS17817 Issued in FL
Practice address
4500 San Pablo Rd S
Jacksonville, FL 32224-1865
Phone
(904) 953-2000
NPI assigned
Jan 25, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 4942 MS
Pain Medicine Physician 208VP0000X OS17817 FL Primary

Addresses

Primary practice location

4500 San Pablo Rd S
Jacksonville, FL 32224-1865

Mailing address

4500 San Pablo Rd S
Jacksonville, FL 32224-1865
Phone (904) 953-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20220624001392 NV Practitioner - Pain Management 4981971397 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pain Management
Education
William Carey University College of Osteopathic Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Custom Physical Therapy Limited PartnershipGroup PAC ID 1355252842, shared by 2 NPIs, 76 clinicians
Jeffrey Zollinger D O PCGroup PAC ID 5597980326, 11 clinicians

Practice addresses (Care Compare)

440 E Golden Valley Rd
Reno, NV 89506-5722
Phone (775) 360-3000

4838 Sparks Blvd
Suite 102
Sparks, NV 89436-8156
Phone (775) 870-1480

Hospital & facility affiliations

  • Renown Regional Medical Center Hospital, Reno, NV, CCN 290001
  • Renown South Meadows Medical Center Hospital, Reno, NV, CCN 290049
  • Northern Nevada Medical Center Hospital, Sparks, NV, CCN 290032

Merit-based Incentive Payment System (MIPS)

Final score
74.37 of 100Reported as individual
Quality
50.48
Improvement activities
40
Cost
80.59

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4942MSMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Jeffrey Zollinger D O PC CurrentSince Jun 15, 2022 Accepting new patients
Sparks Family Hospital Inc Past Accepting new patients
Mt Grant General Hospital Past Accepting new patients
South Lyon Health Center, Inc. Physical Therapist Past Accepting new patients
Prime Healthcare Services - Reno LLC Past Accepting new patients

Locations

412 W John St
Ste B
Carson City, NV 89703
Phone (775) 445-7476

645 N Arlington Ave
Ste 670
Reno, NV 89503
Phone (775) 324-3800

10451 Double R Blvd
Reno, NV 89521
Phone (775) 870-1480

343 Elm St
Ste 202
Reno, NV 89503
Phone (775) 323-6100

4838 Sparks Blvd
Ste 102
Sparks, NV 89436
Phone (775) 870-1480

Organizations & group practices 5

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

Hospital & facility affiliations 9

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": "1327449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674518400000",
    "number": "1689945495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 SAN PABLO RD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322241865",
            "telephone_number": "904-953-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 SAN PABLO RD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322241865",
            "telephone_number": "904-953-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VYDRA",
        "first_name": "DARRELL",
        "middle_name": "GEORGE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-01-25",
        "last_updated": "2023-01-24",
        "certification_date": "2023-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MS",
            "license": "4942",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "FL",
            "license": "OS17817",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.