INTERVENTIONAL SPINE AND PAIN INSTITUTE LLC – Interventional Pain Medicine Physician, NPI 1134880487
Interventional Pain Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for INTERVENTIONAL SPINE AND PAIN INSTITUTE LLC
6559 N Wickham Rd
Melbourne, FL 329402052
Phone: (772) 360-1997
Fax: (772) 492-3541
Type: Location
5200 Babcock St NE Ste 111
Palm Bay, FL 329054639
Phone: (772) 360-1997
Fax: (772) 492-3541
Type: Location
515 ANDROS LN
INDIAN HARBOUR BEACH, FL 329374402
Phone: (908) 303-8044
Type: Mailing
777 37TH ST
VERO BEACH, FL 329604873
Phone: (908) 303-8044
Type: Location
777 37TH ST STE C101
VERO BEACH, FL 329607301
Phone: (772) 360-1997
Fax: (772) 492-3541
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2022-08-17
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20220303001046 | O | Clinic/Group Practice | FL | TBD |
| O20220817001043 | O | Physician - Interventional Pain Management | FL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 32940)
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