NPIMap

Organization Active NPI

Chesapeake Bay ENT PC

  • Specialist
  • Belle Haven, VA
National Provider Identifier
1013106541
Registry record updated Jan 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
CHESAPEAKE BAY ENT PC
Practice address
36080 Lankford Hwy
Belle Haven, VA 23306-0000
Phone
(757) 442-7040
Fax
(757) 442-7080
NPI assigned
Oct 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2014

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

Authorized official

Name
Mrs. Detra Renee Saffold
Title
Regional Practice Administrator
Phone
(757) 442-7040

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

36080 Lankford Hwy
Belle Haven, VA 23306-0000

Mailing address

1270 Diamond Springs Rd
Suite 118, #712
Virginia Beach, VA 23455-3729
Phone (757) 442-7040

Other identifiers 2

IdentifierTypeStateIssuer
006502903MedicaidVA
4102118 00MedicaidMD

Other names 1

  • COASTAL PLAIN ENT Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081201000695 VA Part B Supplier - Clinic/Group Practice 4486715018 Receives reassigned benefits from 15 practitioners
Practice locations: Virginia Beach, VA; Suffolk, VA; Onancock, VA; Portsmouth, VA; Belle Haven, VA; Franklin, VA; Norfolk, VA

National Provider Directory

National Provider Directory

Locations

500 Market St
Ste 105
Pocomoke City, MD 21851
Phone (410) 951-4118

102 Fairview Dr
Ste G
Franklin, VA 23851
Phone (757) 562-6673

130 York St
Norfolk, VA 23510
Phone (757) 935-1400

130 York St
Ste 103
Norfolk, VA 23510

1069 Centerbrooke Ln
Ste 200
Suffolk, VA 23434
Phone (757) 935-1400

1 Columbus Ctr
Ste 500
Virginia Beach, VA 23462
Phone (757) 942-5466

1270 Diamond Springs Rd
Ste 118
Virginia Beach, VA 23455

5701 Cleveland St
Ste 300
Virginia Beach, VA 23462
Phone (757) 942-5466

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1193011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390867200000",
    "number": "1013106541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1270 DIAMOND SPRINGS RD",
            "address_2": "SUITE 118, #712",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234553729",
            "telephone_number": "757-442-7040",
            "fax_number": "757-442-7080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36080 LANKFORD HWY",
            "city": "BELLE HAVEN",
            "state": "VA",
            "postal_code": "233060000",
            "telephone_number": "757-442-7040",
            "fax_number": "757-442-7080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHESAPEAKE BAY ENT PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-22",
        "last_updated": "2014-01-28",
        "status": "A",
        "authorized_official_last_name": "SAFFOLD",
        "authorized_official_first_name": "DETRA",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "REGIONAL PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "757-442-7040",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006502903",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4102118 00",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COASTAL PLAIN ENT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Belle Haven, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.