NPIMap

Organization Active NPI

Formoso Pain Specialists, PA

  • Pain Clinic/Center
  • Jacksonville Beach, FL
National Provider Identifier
1831850494
Registry record updated Feb 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Clinic/CenterTaxonomy code 261QP3300X
Legal business name
FORMOSO PAIN SPECIALISTS, PA
Practice address
1361 13TH Ave S Ste 170
Jacksonville Beach, FL 32250-3235
Phone
(904) 650-2963
NPI assigned
Jan 6, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2022

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

Authorized official

Name
Ferdinand Joseph FormosoNPI 1801000161
Title
Owner
Phone
(904) 588-2393

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Clinic/Center 261QP3300X Primary

Addresses

Primary practice location

1361 13TH Ave S Ste 170
Jacksonville Beach, FL 32250-3235

Mailing address

11555 Central Pkwy Ste 304
Jacksonville, FL 32224-2694
Phone (904) 650-2963

National Provider Directory

National Provider Directory

Locations

5913 Normandy Blvd
Ste 1
Jacksonville, FL 32205
Phone (904) 378-2880

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1641427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644883200000",
    "number": "1831850494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11555 CENTRAL PKWY STE 304",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322242694",
            "telephone_number": "904-650-2963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1361 13TH AVE S STE 170",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322503235",
            "telephone_number": "904-650-2963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORMOSO PAIN SPECIALISTS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-06",
        "last_updated": "2022-02-15",
        "certification_date": "2022-02-15",
        "status": "A",
        "authorized_official_last_name": "FORMOSO",
        "authorized_official_first_name": "FERDINAND",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-588-2393"
    },
    "taxonomies": [
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.