NPIMap

Organization Active NPI

Suffolk United, Inc

  • Internal Medicine Physician
  • Portsmouth, VA
National Provider Identifier
1053017475
Registry record updated Apr 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
SUFFOLK UNITED, INC
Doing business as
PRIMECARE MEDICAL
Practice address
301 Goode Way Ste 102
Portsmouth, VA 23704-2266
Phone
(757) 655-0935
NPI assigned
Feb 7, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2025

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

Authorized official

Name
Taylor Lawrence
Title
Billing Manager
Phone
(757) 372-4407

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

301 Goode Way Ste 102
Portsmouth, VA 23704-2266

Mailing address

732 Eden Way N Ste E104
Chesapeake, VA 23320-2798
Phone (757) 372-4407

Other names 1

  • PRIMECARE MEDICAL Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240610001837 VA Part B Supplier - Clinic/Group Practice 7911449699 Receives reassigned benefits from 10 practitioners
Practice locations: Portsmouth, VA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D2280798Primecare Medical301 Goode Way, Portsmouth, VA 23704Certificate of waiverApr 25, 2027

National Provider Directory

National Provider Directory

Locations

732 Eden Way N
Ste E104
Chesapeake, VA 23320

676 Independence Pkwy
Ste 110
Chesapeake, VA 23320
Phone (757) 970-0353

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 11

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

NPI Registry JSON

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

{
    "created_epoch": "1675728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745452800000",
    "number": "1053017475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "732 EDEN WAY N STE E104",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233202798",
            "telephone_number": "757-372-4407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 GOODE WAY STE 102",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237042266",
            "telephone_number": "757-655-0935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUFFOLK UNITED, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-07",
        "last_updated": "2025-04-24",
        "certification_date": "2025-04-24",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "TAYLOR",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "757-372-4407"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PRIMECARE MEDICAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portsmouth, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.