PCA INTERVENTIONAL SPINE AT FAYETTE, LLC – Pain Clinic/Center, NPI 1447791074

PCA INTERVENTIONAL SPINE AT FAYETTE, LLC is a healthcare provider. based in Fayetteville, Georgia. specializing in Pain Clinic/Center. The organization holds a License No. IN PROCESS (GA). The NPI Number for PCA INTERVENTIONAL SPINE AT FAYETTE, LLC is 1447791074

Main info

Organization
Name
PCA INTERVENTIONAL SPINE AT FAYETTE, LLC
NPI
1447791074
Phone
(404) 351-7654
Address
1233 HIGHWAY 54 W
Authorized Official
DR. RODRIGO DURALDE OWNER MD
Enumeration Date
15 March 2017
Last Update Date
20 February 2026
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience47
Completeness85
Years active:9State licenses:1Digital endpointsOther names

Provider Addresses for PCA INTERVENTIONAL SPINE AT FAYETTE, LLC

  • 1233 HIGHWAY 54 W

    SUITE 205

    FAYETTEVILLE, GA 302144542

    Phone: (404) 351-7654

    Type: Location

  • Peachtree Street, Brookwood, Atlanta, Fulton County, Georgia, 30309, United States

    SUITE 750

    ATLANTA, GA 303092519

    Phone:

    Type: Mailing

  • PO BOX 40061

    BELFAST, ME 049151237

    Phone: (678) 971-4167

    Fax: (833) 989-2501

    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: 2019-03-26

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Past revalidation due date

Earliest CMS due date was 2024-10-31 (588 days ago).

Enrollment records

1

Earliest due date

2024-10-31

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
O20190326001044OAmbulatory Surgical CenterGA2024-10-31

What to do next

  • Verify current status on the CMS Revalidation Lookup Tool immediately.
  • Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
  • Overdue revalidation can lead to deactivation of Medicare billing privileges.

Verify on CMS Revalidation Lookup Tool

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
64483Injection of anesthetic and/or steroid drug into sacral spine nerve root using imaging guidance, single level386175$0
G0260Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography271113$0
64493Injection of lower or sacral spine facet joint using imaging guidance, single level17359$0
64635Destruction of lower or sacral spinal facet joint nerves using imaging guidance, single facet joint13174$0
62321Injection of substance into middle or upper spine canal using imaging guidance5136$0
View full utilization report →

Insurance plans in this area (ZIP 30214)

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Reviews

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Frequently asked questions

What unique ID ties claims to PCA INTERVENTIONAL SPINE AT FAYETTE, LLC?
NPI 1447791074 is assigned to PCA INTERVENTIONAL SPINE AT FAYETTE, LLC under the national enumeration system.
Is PCA INTERVENTIONAL SPINE AT FAYETTE, LLC's NPI currently valid?
The extract we use shows PCA INTERVENTIONAL SPINE AT FAYETTE, LLC as active.
What does PCA INTERVENTIONAL SPINE AT FAYETTE, LLC treat or focus on?
Patients typically see PCA INTERVENTIONAL SPINE AT FAYETTE, LLC under the specialty Pain Clinic/Center. Clinical services aligned with this taxonomy classification.
What location shows for PCA INTERVENTIONAL SPINE AT FAYETTE, LLC?
We surface Fayetteville, Georgia for PCA INTERVENTIONAL SPINE AT FAYETTE, LLC based on available NPPES addresses.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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