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JAX SPINE & PAIN CENTERS
NPI 1194248229
Pain Medicine - Interventional Pain Medicine in St Augustine, FL

Active since July 20, 2017CLIA 10D2008172 · Accreditation
1100 PLANTATION ISLAND DR S STE 220, ST AUGUSTINE, FL 32080(904) 223-3321(904) 223-2169 Get Directions Write a Review

NPPES record last updated: September 26, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 26, 2022, Apr 29, 2021, Jul 20, 2017 (3 updates tracked since 2017).

About Jax Spine & Pain Centers NPPES

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

JAX SPINE & PAIN CENTERS (NPI 1194248229) is a healthcare organization registered as an interventional pain medicine in St Augustine, Florida and active in the NPI registry since July 2017. The organization holds an CLIA Accreditation certificate valid through July 30, 2027 and lists Alicia Groth, Credentialing Specialist, as its authorized official.

NPPES Registry Identity

NPI1194248229
Entity TypeOrganization
Primary Taxonomy208VP0014X
Legal Business NameJACKSONVILLE SPINE CENTER PA
Location Address1100 PLANTATION ISLAND DR S STE 220St Augustine, FL 32080-5174
Mailing Address5191 First Coast Tech Pkwy, 3rd FloorJacksonville, FL 32224 · (904) 223-3321 · Fax (904) 223-2169
Phone(904) 223-3321
Fax(904) 223-2169
Organization SubpartNo
Authorized OfficialAlicia GrothCredentialing Specialist · (904) 223-3321
Enumeration DateJuly 20, 2017
Last NPPES UpdateSeptember 26, 20223 updates tracked since enumeration
NPPES CertifiedSeptember 20, 2022
✔ NPI 1194248229 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ 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.
1100 PLANTATION ISLAND DR S STE 220, St Augustine, FL 32080
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Other Names 1

Doing Business AsJax Spine & Pain Centers

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Florida Blue (BlueCross BlueShield FL), Florida Blue HMO (a BlueCross BlueShield FL company).Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Accreditation 10D2008172

Jacksonville Spine Center · Jacksonville, FL
Active · expires Jul 30, 2027
CLIA Number10D2008172
Laboratory TypePhysician Office
Certificate Effective DateJuly 31, 2025
Certificate Expiration DateJuly 30, 2027
Laboratory DirectorDr. Ahmed Ibrahim
Laboratory Phone(904) 223-3321
Laboratory LocationJacksonville Spine Center5191 First Coast Tech Pkwy Floor 3, Jacksonville, FL 32224
CLIA data matches this NPI record on: Address Name Phone
This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KASSIA C SILVA
Pain Medicine (Interventional Pain Medicine)
1100 PLANTATION ISLAND DR S STE 220
ST AUGUSTINE, FL 32080
St. Johns County (904) 223-3321
MR. ROBERT P. WEBER PA-C
Physician Assistant
1100 PLANTATION ISLAND DR S STE 220
ST AUGUSTINE, FL 32080
St. Johns County (904) 223-3321
EMMA KLECKNER DNP
Nurse Practitioner (Family)
1100 PLANTATION ISLAND DR S STE 220
SAINT AUGUSTINE, FL 32080
St. Johns County (904) 223-3321
JOSHUA B MASSEY PA
Physician Assistant
1100 PLANTATION ISLAND DR S STE 220
ST AUGUSTINE, FL 32080
St. Johns County (904) 223-3321
DR. MICHAEL CHRISTOPHER HANES M.D.
Pain Medicine (Interventional Pain Medicine)
1100 PLANTATION ISLAND DR S STE 220
SAINT AUGUSTINE, FL 32080
St. Johns County (904) 223-3321
KELLI M. TYSON ARNP
Nurse Practitioner
1100 PLANTATION ISLAND DR S STE 220
ST AUGUSTINE, FL 32080
St. Johns County (904) 223-3321

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 Jacksonville Spine Center PA's NPI number?

The NPI number for Jacksonville Spine Center PA is 1194248229. It was assigned to this organization in the NPPES registry on July 20, 2017. The provider is doing business as Jax Spine & Pain Centers.

Where is Jacksonville Spine Center PA located?

Jacksonville Spine Center PA is located at 1100 Plantation Island Dr S Ste 220, St Augustine, FL 32080. The listed phone number is (904) 223-3321.

What is Jacksonville Spine Center PA's specialty?

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

Does Jacksonville Spine Center PA hold a CLIA laboratory certificate?

Yes. A Certificate of Accreditation (number 10D2008172) is associated with this NPI, valid through July 30, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Jacksonville Spine Center PA accept?

Health plans from Florida Blue (BlueCross BlueShield FL) and Florida Blue HMO (a BlueCross BlueShield FL company) list Jacksonville Spine Center PA as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jacksonville Spine Center PA was last updated on September 26, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.