Centurion Spine & Pain Centers – Interventional Pain Medicine Physician, NPI 1902852130
Interventional Pain Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Centurion Spine & Pain Centers
200 Blue Moon Xing Ste 203
Pooler, GA 313229698
Phone: (912) 254-7896
Type: Location
195 E Tollison St
Baxley, GA 315130172
Phone: (912) 590-0973
Fax: (912) 590-0180
Type: Location
1218 Alice St
Waycross, GA 315014525
Phone: (912) 590-0973
Fax: (912) 590-0180
Type: Location
5191 FIRST COAST TECH PKWY FL 3
JACKSONVILLE, FL 322240609
Phone: (904) 256-2754
Fax: (904) 223-2169
Type: Mailing
3408 TROUT ST
BRUNSWICK, GA 315203622
Phone: (912) 466-9111
Fax: (912) 466-0366
Type: Location
10475 CENTURION PKWY N STE 201
JACKSONVILLE, FL 322565004
Phone: (904) 223-3321
Fax: (904) 223-2169
Type: Mailing
3221 GLYNN AVE # 100
BRUNSWICK, GA 315204851
Phone: (912) 466-9111
Fax: (912) 466-0366
Type: Location
3221, Glynn Avenue, Brunswick, Glynn County, Georgia, 31520, United States
BRUNSWICK, GA 315204851
Phone: (912) 466-9111
Fax: (912) 466-0366
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: 2010-11-02
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-09-30 (986 days ago).
Enrollment records
2
Earliest due date
2023-09-30
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 |
|---|---|---|---|---|
| O20040923000559 | O | Clinic/Group Practice | GA | 2023-09-30 |
| O20101102001515 | O | Physician - Anesthesiology | GA | 2025-11-30 |
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.
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 31322)
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