Individual provider Active NPI

Maia Kokichashvili, MD

  • Internal Medicine Physician
  • Norfolk, VA
National Provider Identifier
1043278864
Registry record updated Jan 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
0101243380 Issued in VA
Practice address
600 Gresham Dr FL 5
Norfolk, VA 23507-1904
Phone
(757) 388-3198
Fax
(757) 388-4242
NPI assigned
May 2, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NE23395 NE
Hospitalist Physician 208M00000X 0101243380 VA
Internal Medicine Physician 207R00000X 0101243380 VA Primary

Addresses

Primary practice location

600 Gresham Dr FL 5
Norfolk, VA 23507-1904

Mailing address

600 Gresham Dr FL 5
Norfolk, VA 23507-1904
Phone (757) 388-3198

Other practice location 1

1975 Glenn Mitchell Dr
VA Beach, VA 23456-0167
Phone (757) 967-8622

Other identifiers 4

IdentifierTypeStateIssuer
NE23395MedicaidNE
P00234141OtherNERAILROAD MEDICARE NUMBER
247598OtherNEMIDLANDS CHOICE PROVIDER
30375OtherNEBC BS IDENTIFICATION NUMB

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090602000071 VA Practitioner - HospitalistPractitioner - Internal Medicine 1153352901 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sentara Medical GroupGroup PAC ID 8921903923, 1,396 clinicians

Practice addresses (Care Compare)

301 Riverview Ave
Suite 400
Norfolk, VA 23510-1065
Phone (757) 252-1700

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
NE23395NEMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Bayview Physician Services, PC CurrentSince Jun 1, 2009 Accepting new patients
Sentara Medical Group Internal Medicine CurrentSince Sep 18, 2017 Accepting new patients
Bayview Physician Services, PC Internal Medicine CurrentSince Jun 1, 2009 Accepting new patients
Niobrara Valley Hospital Corporation Past Accepting new patients

Locations

111 Mill Creek Pkwy
Chesapeake, VA 23323
Phone (757) 558-8210

301 Riverview Ave
Ste 400
Norfolk, VA 23510
Phone (757) 252-1700

850 Kempsville Rd
Norfolk, VA 23502
Phone (757) 261-0162

600 Gresham Dr
Ste 5B
Norfolk, VA 23507
Phone (757) 388-3198

600 Gresham Dr
Fl 5
Norfolk, VA 23507
Phone (757) 388-3198

1975 Glenn Mitchell Dr
Virginia Beach, VA 23456
Phone (757) 481-2313

100 Sentara Cir
Williamsburg, VA 23188
Phone (678) 690-7826

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/niobra-b6726789

Organizations & group practices 4

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

Hospital & facility affiliations 2

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": "1146528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579651200000",
    "number": "1043278864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 GRESHAM DR FL 5",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071904",
            "telephone_number": "757-388-3198",
            "fax_number": "757-388-4242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 GRESHAM DR FL 5",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071904",
            "telephone_number": "757-388-3198",
            "fax_number": "757-388-4242"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1975 Glenn Mitchell Dr",
            "address_purpose": "LOCATION",
            "city": "VA Beach",
            "state": "VA",
            "postal_code": "234560167",
            "country_code": "US",
            "telephone_number": "757-967-8622",
            "fax_number": "757-686-0541",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOKICHASHVILI",
        "first_name": "MAIA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-02",
        "last_updated": "2020-01-22",
        "certification_date": "2020-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NE",
            "license": "NE23395",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "VA",
            "license": "0101243380",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101243380",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NE23395",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE NUMBER",
            "identifier": "P00234141",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIDLANDS CHOICE PROVIDER",
            "identifier": "247598",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS IDENTIFICATION NUMB",
            "identifier": "30375",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norfolk, VA

Sources for this page

Verify at the official NPI Registry.