ADVANCED SPINE AND PAIN CENTER, P.A. (NPI# 1376902775) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376902775 |
| Entity Type | Organization |
| Organization Name | ADVANCED SPINE AND PAIN CENTER, P.A. |
| Practice Address |
518 Sandhurst Dr Fayetteville NC 28304-4426 |
| Practice Telephone | 9103398475 |
| Enumeration Date | 2016-02-15 |
| Last Update Date | 2016-02-15 |
| Authorized Official Name | RACHID IDRISSI (PHYSICIAN OWNER) |
| Authorized Official Telephone | 9103398475 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208VP0000X |
Pain Medicine Specialization: Pain Medicine |
Allopathic & Osteopathic Physicians | ||
| Y | 2081P2900X |
Physical Medicine & Rehabilitation Specialization: Pain Medicine |
Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003275603 | Advanced Spine and Pain Center, P.a. | Pain Medicine | 166 Springbrook Ave, Suite 105, Clayton, NC 27520-8520 | 2016-02-11 |
| 1255799375 | Advanced Spine and Pain Center, P.a. | Pain Medicine | 1 Medical Dr, Benson, NC 27504-1177 | 2016-02-03 |
| 1639317332 | Advanced Spine and Pain Center, P.a. | Pain Medicine | 1 Medical Dr, Benson, NC 27504-1177 | 2009-02-03 |
| Street Address |
518 SANDHURST DR |
| City | FAYETTEVILLE |
| State | NC |
| Zip Code | 28304-4426 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265401962 | Hasumati Vijaykumar Mehta | Family Medicine | 518 Sandhurst Dr, Fayetteville, NC 28304-4426 | 2006-03-15 |
| 1235597493 | Advanced Spine and Pain Center | Pain Medicine | 518 Sandhurst Dr, Fayetteville, NC 28304-4426 | 2016-02-03 |
| 1730351073 | Mehta Medical Services | Family Medicine | 518 Sandhurst Dr, Fayetteville, NC 28304-4426 | 2008-03-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598301061 | Coast To Coast Bilingual Counseling | Social Worker | 910 Hope Mills Road, Fayetteville, NC 28304 | 2019-11-20 |
| 1811530561 | Frances L. Hurst | Technician | 6732 Carloway Dr, Fayetteville, NC 28304 | 2019-10-25 |
| 1538717764 | Rose Mary A O'conner | Technician | 3530 Madison Ave, Fayetteville, NC 28304 | 2019-08-30 |
| 1932756087 | Sally Frances Jones | Technician | 2053 Mango Circle, Fayetteville, NC 28304 | 2019-08-23 |
| 1326528803 | Jeneen Yvette Townsend | Counselor | 2671 Adams Lake Dr Apt F, Fayetteville, NC 28304 | 2018-08-15 |
| 1780179580 | Ma Cornelia Villavicencio Leano | Nurse Practitioner | 3081 Stone Carriage Cir Apt Z, Fayetteville, NC 28304 | 2018-06-25 |
| 1861986267 | Pediatric After Hours Care of Fayetteville | Pediatrics | 556 Sandhurst Drive, Fayetteville, NC 28304 | 2018-06-19 |
| 1700386133 | Good Night Medical of Ohio, LLC | Durable Medical Equipment & Medical Supplies | 405 Owen Dr Ste 202, Fayetteville, NC 28304 | 2018-02-12 |
| 1003321365 | Valleygate Dental Surgery Center of Fayetteville, LLC | Dentist | 2038 Litho Place, Fayetteville, NC 28304 | 2017-12-08 |
| 1871004663 | The Salt Project | Marriage & Family Therapist | 1611-b Owen Dr., Fayetteville, NC 28304 | 2017-10-19 |
| Find all providers in zip 28304 | ||||
| Taxonomy Code | 2081P2900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Physical Medicine & Rehabilitation |
| Specialization | Pain Medicine |
| A physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source changed] Additional Resources: American Board of Physical Medicine and Rehabilitation, 2007. http://www.abpmr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Physical Medicine and Rehabilitation. A subspecialty certificate was approved by the ABMS in 1999. ACGME Accredited Residency Program Requirements: Proposal under development. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366471211 | Mary Frances Daut | Physical Medicine & Rehabilitation | 1708 E Joyce Blvd, Ste 3, Fayetteville, AR 72703-5252 | 2006-07-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659836591 | Advanced Regenerative Care, Pllc | Physical Medicine & Rehabilitation | 504 C Red Banks Road, Greenville, NC 27858 | 2019-02-05 |
| 1992160659 | Carolina Sports and Spine | Physical Medicine & Rehabilitation | 1700 Forest Hills Rd W, Wilson, NC 27893-3411 | 2015-12-23 |
| 1811399850 | Mitchell Bloom | Physical Medicine & Rehabilitation | Oak Branch Drive, Suite 7e, Greensboro, NC 27407-2380 | 2014-09-22 |
| 1881619005 | Fan Xi | Physical Medicine & Rehabilitation | 2800 Ashton Drive, Suite 100, Wilmington, NC 28412-2486 | 2006-07-12 |
| 1093753329 | Edward Anthony Overton | Physical Medicine & Rehabilitation | 10310 Mallard Creek Rd, Ste 101-c, Charlotte, NC 28262-9771 | 2006-06-02 |
| 1487632881 | Mark Allen Goodson | Physical Medicine & Rehabilitation | 114 Welton Way Ste A, Mooresville, NC 28117-9251 | 2006-01-05 |
| 1083696892 | Ronald Vandernoord | Physical Medicine & Rehabilitation | 710 Park Center Dr Ste 300, Matthews, NC 28105-5082 | 2005-11-17 |
| 1922095520 | Angelo Tellis | Physical Medicine & Rehabilitation | 2111 Neuse Blvd. Suite J, New Bern, NC 28560-4317 | 2005-09-29 |
| 1578569166 | Thomas Francis Florian | Physical Medicine & Rehabilitation | 4901 Dawn Dr, Suite 3300, Lumberton, NC 28360-8287 | 2005-06-28 |
| 1619524097 | Novant Medical Group Inc | Physical Medicine & Rehabilitation | 3515 W Market St Ste 210, Greensboro, NC 27403-4442 | 2019-08-21 |
| Find all providers with the same taxonomy | ||||
| City | FAYETTEVILLE |
| Zip Code | 28304 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.