Coastal Health – Pain Medicine Physician, NPI 1699170035
Pain Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Coastal Health
13241 BARTRAM PARK BLVD
SUITE 1101
JACKSONVILLE, FL 322585212
Phone: (904) 288-8311
Fax: (904) 288-8371
Type: Location
3839 COUNTY ROAD 218
MIDDLEBURG, FL 320685708
Phone: (904) 751-4906
Fax: (904) 714-3574
Type: Mailing
705 WELLS RD STE 300
ORANGE PARK, FL 320732982
Phone: (904) 282-6331
Fax: (904) 619-1080
Type: Mailing
1811 BLANDING BLVD STE 102
MIDDLEBURG, FL 320684935
Phone: (904) 661-2394
Fax: (904) 621-9105
Type: Location
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: 2025-05-30
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
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 |
|---|---|---|---|---|
| O20250530000054 | O | Multi-Specialty - Physician | 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 32258)
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