SPINE AND PAIN REGENERATIVE MEDICINE
NPI 1114764107
Pain Medicine - Interventional Pain Medicine in Fairfax, VA

Q: What is Spine And Sports Regenerative Medicine Institute's specialty?

The primary specialty registered for this NPI is Pain Medicine, specializing in Interventional Pain Medicine, with taxonomy code 208VP0014X.

Active since July 09, 2024

10721 MAIN ST STE 304, FAIRFAX, VA 22030(703) 349-4205(703) 349-4205 Get Directions Write a Review

NPPES record last updated: July 16, 2024. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Jul 16, 2024, Jul 9, 2024 (2 updates tracked since 2024).

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About Spine And Pain Regenerative Medicine NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SPINE AND PAIN REGENERATIVE MEDICINE (NPI 1114764107) is a healthcare organization registered as an interventional pain medicine in Fairfax, Virginia and active in the NPI registry since July 2024. The organization lists David Kim, Ceo, as its authorized official.

NPPES Registry Identity

NPI1114764107

Entity TypeOrganization

Primary Taxonomy208VP0014X

Legal Business NameSPINE AND SPORTS REGENERATIVE MEDICINE INSTITUTE

Location Address10721 MAIN ST STE 304Fairfax, VA 22030-6902

Mailing Address10721 Main St Ste 304Fairfax, VA 22030-6902 · (703) 349-4205 · Fax (703) 349-4205

Phone(703) 349-4205

Fax(703) 349-4205

Organization SubpartNo

Authorized OfficialDavid KimCeo · (703) 349-4205

Enumeration DateJuly 9, 2024

Last NPPES UpdateJuly 16, 20242 updates tracked since enumeration

NPPES CertifiedJuly 16, 2024

✔ NPI 1114764107 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPain Medicine · Interventional Pain MedicineAllopathic & Osteopathic Physicians

Taxonomy Code208VP0014X

Definition

Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment.

Also ListedPain Medicine · Pain MedicineTaxonomy 208VP0000X

10721 MAIN ST STE 304, Fairfax, VA 22030

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Other Names 1

Doing Business AsSpine And Pain Regenerative Medicine

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Spine And Pain Regenerative Medicine is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Spine And Pain Regenerative Medicine, which bills Medicare for the services this clinician delivers.

Clinician (1)

David Kim, MD

Physical Medicine and Rehabilitation

NPI 1073530523

10721 MAIN ST STE 304
Fairfax, VA 22030

(703) 349-4205

✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Spine And Sports Regenerative Medicine Institute's NPI number?

The NPI number for Spine And Sports Regenerative Medicine Institute is 1114764107. It was assigned to this organization in the NPPES registry on July 9, 2024. The provider is doing business as Spine And Pain Regenerative Medicine.

Where is Spine And Sports Regenerative Medicine Institute located?

Spine And Sports Regenerative Medicine Institute is located at 10721 Main St Ste 304, Fairfax, VA 22030. The listed phone number is (703) 349-4205.

What is Spine And Sports Regenerative Medicine Institute's specialty?

The primary specialty registered for this NPI is Pain Medicine, specializing in Interventional Pain Medicine, with taxonomy code 208VP0014X.

Is Spine And Sports Regenerative Medicine Institute enrolled in Medicare?

Yes. Spine And Sports Regenerative Medicine Institute is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Spine And Sports Regenerative Medicine Institute?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Physical Medicine and Rehabilitation) reassigns their Medicare billing to Spine And Sports Regenerative Medicine Institute. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Spine And Sports Regenerative Medicine Institute was last updated on July 16, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.