NPIMap

Individual provider Active NPI

Thaiduc Nguyen, DO

  • Pain Medicine (Anesthesiology) Physician
  • Merritt Island, FL
National Provider Identifier
1912092107
Registry record updated Aug 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
OS13604 Issued in FL
Practice address
595 N Courtenay Pkwy Ste 101
Merritt Island, FL 32953-4852
Phone
(321) 784-8211
Fax
(321) 394-9425
NPI assigned
Oct 4, 2006
Last updated
Aug 15, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2019

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 34 008818 OH
Anesthesiology Physician 207L00000X OS13604 FL
Pain Medicine (Anesthesiology) Physician 207LP2900X 34008818 OH
Pain Medicine (Anesthesiology) Physician 207LP2900X OS13604 FL Primary

Addresses

Primary practice location

595 N Courtenay Pkwy Ste 101
Merritt Island, FL 32953-4852

Mailing address

595 N Courtenay Pkwy Ste 101
Merritt Island, FL 32953-4852
Phone (321) 784-8211

Other identifiers 1

IdentifierTypeStateIssuer
2699003MedicaidOH

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
I20160910000007 FL Practitioner - AnesthesiologyPractitioner - Pain Management 6305843616 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
AnesthesiologyAlso: Pain Management
Education
Arizona College of Osteopathic Medicine Mid Western University, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tampa Pain Relief Center IncGroup PAC ID 6002715158, 33 clinicians

Practice addresses (Care Compare)

595 N Courtenay Pkwy
Suite 101
Merritt Island, FL 32953-4852
Phone (321) 784-8211

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.72 of 100Reported as group
Promoting interoperability
78
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34 008818OHMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tampa Pain Relief Center, Inc. CurrentSince Aug 1, 2016 Accepting new patients
Seven Hills Anesthesia, LLC Anesthesiology Past Accepting new patients
Physicians Anesthesia Service Inc Anesthesiology Past Accepting new patients
Licking Memorial Professional Corporation Anesthesiology Past Accepting new patients
Grady Anesthesia Services, Inc Past Accepting new patients

Locations

325 Waymont Ct
Ste 111
Lake Mary, FL 32746
Phone (407) 585-0263

5545 N Wickham Rd
Ste 104
Melbourne, FL 32940
Phone (321) 784-8211

595 N Courtenay Pkwy
Ste 101
Merritt Island, FL 32953
Phone (321) 784-8211

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: thaiduc.nguyen.p2@direct.painreliefcenters.nextgenshare.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565827200000",
    "number": "1912092107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "595 N COURTENAY PKWY STE 101",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329534852",
            "telephone_number": "321-784-8211",
            "fax_number": "321-394-8425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 N COURTENAY PKWY STE 101",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329534852",
            "telephone_number": "321-784-8211",
            "fax_number": "321-394-9425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "THAIDUC",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2019-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OH",
            "license": "34 008818",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "FL",
            "license": "OS13604",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "OH",
            "license": "34008818",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "FL",
            "license": "OS13604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2699003",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Merritt Island, FL

Sources for this page

Verify at the official NPI Registry.