NPIMap

Individual provider Active NPI

Haidr Agha, M.D.

  • Nephrology Physician
  • Virginia Beach, VA
National Provider Identifier
1003048117
Registry record updated Jan 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
0101251568 Issued in VA
Practice address
1157 First Colonial Rd
Ste 200
Virginia Beach, VA 23454
Phone
(757) 623-0005
Fax
(757) 389-5383
NPI assigned
Aug 24, 2009
Last updated
Jan 20, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 0101251568 VA Primary

Addresses

Primary practice location

1157 First Colonial Rd
Ste 200
Virginia Beach, VA 23454

Mailing address

4445 Corporation LN Ste 100
Virginia Beach, VA 23462-3666
Phone (757) 623-0005

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140626002313 VA Practitioner - NephrologyPractitioner - Emergency Medicine 8729215157 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Tidewater Kidney Specialists IncGroup PAC ID 6507852662, 21 clinicians

Practice addresses (Care Compare)

1200 1St Colonial Rd
Suite 202
Virginia Beach, VA 23454-2207
Phone (757) 623-0005

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Tidewater Kidney Specialists, Inc. Nephrology CurrentSince Aug 1, 2014 Accepting new patients
Tidewater Kidney Specialists, Inc. Nephrology CurrentSince Aug 1, 2014 Accepting new patients
Renal Treatment Centers Mid Atlantic Inc Past Accepting new patients

Locations

301 Riverview Ave
Ste 512
Norfolk, VA 23510
Phone (757) 627-5116

814 Kempsville Rd
Ste 102
Norfolk, VA 23502

1200 First Colonial Rd
Ste 202
Virginia Beach, VA 23454
Phone (757) 481-0385

4445 Corporation Ln
Ste 100
Virginia Beach, VA 23462

4560 South Blvd
Ste 202
Virginia Beach, VA 23452
Phone (757) 340-6100

Interoperability endpoints

  • Direct secure messaging: haidragha@tks.allscriptsdirect.net

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1251072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642636800000",
    "number": "1003048117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4445 CORPORATION LN STE 100",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234623666",
            "telephone_number": "757-623-0005",
            "fax_number": "757-548-1129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1157 FIRST COLONIAL RD",
            "address_2": "STE 200",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "23454",
            "telephone_number": "757-623-0005",
            "fax_number": "757-389-5383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGHA",
        "first_name": "HAIDR",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-24",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "VA",
            "license": "0101251568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

Verify at the official NPI Registry.