NPIMap

Organization Active NPI

Advanced Pain Clinic PA

  • Pain Medicine (Anesthesiology) Physician
  • Kissimmee, FL
National Provider Identifier
1861470049
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
ME0066759 Issued in FL
Legal business name
ADVANCED PAIN CLINIC PA
Practice address
505 W Vine St
Suite 301
Kissimmee, FL 34741-4156
Phone
(407) 935-9404
Fax
(407) 935-9304
NPI assigned
Jan 6, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Vrajlal L Rajyaguru, MDNPI 1134348014
Title
President
Phone
(407) 935-9404

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X ME0066759 FL
Pain Medicine (Anesthesiology) Physician 207LP2900X ME0066759 FL Primary
Pain Clinic/Center 261QP3300X FL

Addresses

Primary practice location

505 W Vine St
Suite 301
Kissimmee, FL 34741-4156

Mailing address

505 W Vine St
Suite # 301
Kissimmee, FL 34741-4156
Phone (407) 935-9404

Other identifiers 1

IdentifierTypeStateIssuer
377046000MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080429000694 FL Part B Supplier - Clinic/Group Practice 5597844795 Receives reassigned benefits from 2 practitioners
Practice locations: Kissimmee, FL; Ocoee, FL; Haines City, FL

National Provider Directory

National Provider Directory
Tax ID family
Advanced Pain Clinic PA4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

514 Cypress Pkwy
Kissimmee, FL 34759
Phone (407) 935-9404

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1136505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1861470049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 W VINE ST",
            "address_2": "SUITE # 301",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347414156",
            "telephone_number": "407-935-9404",
            "fax_number": "407-935-9304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 W VINE ST",
            "address_2": "SUITE 301",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347414156",
            "telephone_number": "407-935-9404",
            "fax_number": "407-935-9304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED PAIN CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-06",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "RAJYAGURU",
        "authorized_official_first_name": "VRAJLAL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "407-935-9404",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "FL",
            "license": "ME0066759",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "FL",
            "license": "ME0066759",
            "primary": true
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": "FL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "377046000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kissimmee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.