NPIMap

Organization Active NPI

Jacksonville Spine Center PA

Doing business as Jax Spine & Pain Centers

  • Pain Medicine (Anesthesiology) Physician
  • Jacksonville, FL
National Provider Identifier
1881643757
Registry record updated May 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
Legal business name
JACKSONVILLE SPINE CENTER PA
Doing business as
Jax Spine & Pain Centers
Practice address
5191 First Coast Tech Pkwy
Jacksonville, FL 32224
Phone
(904) 223-3321
Fax
(904) 223-2169
NPI assigned
May 9, 2006
Last updated
May 9, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2023

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

Authorized official

Name
Alicia M Groth
Title
Credentialing Specialist
Phone
(904) 223-3321

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X NU Primary
Interventional Pain Medicine Physician 208VP0014X NU

Addresses

Primary practice location

5191 First Coast Tech Pkwy
Jacksonville, FL 32224

Mailing address

5191 First Coast Tech Pkwy
3Rd Floor
Jacksonville, FL 32224
Phone (904) 223-3321

Other identifiers 3

IdentifierTypeStateIssuer
1912978149OtherFLNPI#-CHRISTOPHER ROBERTS
1285604793OtherFLNPI # CLAUDIO VINCENTY
1821069055OtherFLNPI#-JOHN CAREY, M.D.

Other names 1

  • Jax Spine & Pain Centers Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040408001580 FL Part B Supplier - Clinic/Group Practice 6901890300 Receives reassigned benefits from 38 practitioners
Practice locations: Palatka, FL; Jacksonville Beach, FL; St Augustine, FL; Fleming Island, FL; Jacksonville, FL; Fernandina Beach, FL
O20100930018097 FL DME Supplier - Physician - Interventional Pain Management 6901890300 Practice locations: Jacksonville, FL

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2008172Jacksonville Spine Center5191 First Coast Tech Pkwy Floor 3, Jacksonville, FL 32224AccreditationJul 30, 2027

National Provider Directory

National Provider Directory

Locations

10475 Centurion Pkwy N
Ste 304
Jacksonville, FL 32256
Phone (904) 270-2673

15255 Max Leggett Pkwy
Ste 5500
Jacksonville, FL 32218

5191 First Coast Tech Pkwy
Fl Third
Jacksonville, FL 32224

Practitioners & affiliated clinicians

Practitioners 49

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 49

NPI Registry JSON

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683590400000",
    "number": "1881643757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5191 FIRST COAST TECH PKWY",
            "address_2": "3RD FLOOR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32224",
            "telephone_number": "904-223-3321",
            "fax_number": "904-223-2169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5191 FIRST COAST TECH PKWY",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32224",
            "telephone_number": "904-223-3321",
            "fax_number": "904-223-2169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE SPINE CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-09",
        "last_updated": "2023-05-09",
        "certification_date": "2023-05-09",
        "status": "A",
        "authorized_official_last_name": "GROTH",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "904-223-3321"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI#-CHRISTOPHER ROBERTS",
            "identifier": "1912978149",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI # CLAUDIO VINCENTY",
            "identifier": "1285604793",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI#-JOHN CAREY, M.D.",
            "identifier": "1821069055",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jax Spine & Pain Centers",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jax Spine & Pain Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.