Tidewater Kidney Specialists, Inc.

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

TIDEWATER KIDNEY SPECIALISTS, INC.

Doing business as

Tidewater Vascular Access Center

Practice address

814 Kempsville Rd
Suite 101
Norfolk, VA 23502-4001

Phone

(757) 623-0005

Fax

(757) 548-1129

NPI assigned

Apr 18, 2012

Last updated

Jan 20, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Elizabeth F Skidmore

Title

Practice Administrator

Phone

(757) 623-0005

Specialties & licenses 3

Addresses

Other names 1

• Tidewater Vascular Access Center Doing business as

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Tidewater Kidney Specialists, Inc.

  • Nephrology Physician
  • Virginia Beach, VA
  • NPI 1780624627

  O20040519001509

  Same enrollment

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

CLIA laboratory certificates

Locations

Practitioners 38

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Haidr Agha, M.D.

  • Nephrology Physician
  • Virginia Beach, VA
  • NPI 1003048117
  NPD
• Malik Asad Anjum, M.D.

  • Nephrology Physician
  • Norfolk, VA
  • NPI 1386902104

  Single Specialty

  NPD
• Dawn Louise Bethea, ARNP

  • Family Nurse Practitioner
  • Chesapeake, VA
  • NPI 1346542800
  NPD
• Daniel Joseph Dean Jr., D.O.

  • Nephrology Physician
  • Portsmouth, VA
  • NPI 1922329754
  NPD
• Kiranjit Kaur Dhillon, MD

  • Nephrology Physician
  • Norfolk, VA
  • NPI 1598722803
  NPD
• Sam Wei Gao, MD

  • Nephrology Physician
  • Portsmouth, VA
  • NPI 1831181650
  NPD
• Angela Garcia, NP

  • Family Nurse Practitioner
  • Virginia Beach, VA
  • NPI 1144656133
  NPD
• Alexander Olegovich Gogoli, DO

  • Internal Medicine Physician
  • Harrisonburg, VA
  • NPI 1902435639
  NPD
• Liwei E. Huang, MD

  • Nephrology Physician
  • Chesapeake, VA
  • NPI 1912174939
  NPD
• Yury Kalmanovich, MD

  • Nephrology Physician
  • Norfolk, VA
  • NPI 1992796767
  NPD
• Madhu K Kolli, MD

  • Nephrology Physician
  • Virginia Beach, VA
  • NPI 1114900552
  NPD
• Steven Victor Lewinski, M.D.

  • Nephrology Physician
  • Chesapeake, VA
  • NPI 1992788244
  NPD

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

{
    "created_epoch": "1334707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642636800000",
    "number": "1053678839",
    "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": "814 KEMPSVILLE RD",
            "address_2": "SUITE 101",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235024001",
            "telephone_number": "757-623-0005",
            "fax_number": "757-548-1129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER KIDNEY SPECIALISTS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-18",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A",
        "authorized_official_last_name": "SKIDMORE",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "757-623-0005",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tidewater Vascular Access Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tidewater Vascular Access Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tidewater Dental Center, PLLC
• Tidewater Dermatopathology Service, Inc
• Tidewater Diagnostic Consultants, LLC (Tidewater Mobile Phlebotomy Service)
• Tidewater Home Care, Inc.
• Tidewater Hyperbaric
• Tidewater Pastoral Counseling Services, Inc
• Tidewater Physical Therapy LLC (Pivot Physical Therapy of Virginia)
• Tidewater Physical Therapy LLC (Pivot Physical Therapy of Virginia)
• Tidewater Physical Therapy, LLC
• Tidewater Podiatry Group LTD

• Nephrology Physician in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Nephrology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2022; 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.