Individual provider Active NPI

John S Tiedeman, MD

  • Anesthesiology Physician
  • Charlottesville, VA
National Provider Identifier
1104047307
Registry record updated Jul 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
0101243857 Issued in VA
Practice address
459 Locust Ave
Charlottesville, VA 22902-4808
Phone
(434) 296-7733
NPI assigned
May 2, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 0101243857 VA Primary

Addresses

Primary practice location

459 Locust Ave
Charlottesville, VA 22902-4808

Mailing address

311 10TH St NE
Charlottesville, VA 22902-5316
Phone (434) 296-7733

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
I20080717000624 VA Practitioner - Anesthesiology 8729151113 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Virginia School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SMG Anesthesia Specialists LLCGroup PAC ID 6305081118, 501 clinicians

Practice addresses (Care Compare)

2025 Glenn Mitchell Dr
Virginia Beach, VA 23456-0178
Phone (757) 507-1000

Hospital & facility affiliations

  • Sentara Martha Jefferson Hospital Hospital, Charlottesville, VA, CCN 490077
  • Sentara Norfolk General Hospital Hospital, Norfolk, VA, CCN 490007

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101243857VAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
SMG Anesthesia Specialists LLC Anesthesiology CurrentSince Jul 1, 2020 Accepting new patients
Commonwealth Anesthesia Associates, P.C. Anesthesiology CurrentSince Feb 2, 2021 Accepting new patients
Uva Community Health Medical Group, LLC CurrentSince Nov 20, 2024 Accepting new patients

Locations

500 Martha Jefferson Dr
Charlottesvle, VA 22911
Phone (434) 654-7000

4105 Lewis and Clark Dr
Charlottesvle, VA 22911

501 Sunset Ln
Culpeper, VA 22701
Phone (540) 829-4100

10800 Midlothian Tpke
Ste 265
North Chesterfield, VA 23235
Phone (804) 594-1383

7101 Jahnke Rd
Richmond, VA 23225
Phone (804) 323-1088

2025 Glenn Mitchell Dr
Virginia Beach, VA 23456
Phone (757) 507-1000

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 and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214956800000",
    "number": "1104047307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 10TH ST NE",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229025316",
            "telephone_number": "434-296-7733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "459 LOCUST AVE",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229024808",
            "telephone_number": "434-296-7733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIEDEMAN",
        "first_name": "JOHN",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-02",
        "last_updated": "2008-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "VA",
            "license": "0101243857",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlottesville, VA

Sources for this page

Verify at the official NPI Registry.