NPIMap

Individual provider Active NPI

Tierra Nicole Leak, MD

  • Family Medicine Physician
  • Virginia Beach, VA
National Provider Identifier
1104314509
Registry record updated May 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101278323 Issued in VA
Practice address
5320 Providence Rd Ste 301
Virginia Beach, VA 23464-4122
Phone
(757) 413-7600
NPI assigned
May 1, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD474955 PA
Family Medicine Physician 207Q00000X 0101278323 VA Primary

Addresses

Primary practice location

5320 Providence Rd Ste 301
Virginia Beach, VA 23464-4122

Mailing address

5320 Providence Rd Ste 301
Virginia Beach, VA 23464-4122
Phone (757) 413-7600

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tleak205578@phsdirect.pinnaclehealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, VA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210727000291 PA Practitioner - Family Practice 2668875899 Reassigns benefits to 1 organization
I20240212003657 VA Practitioner - Family Practice 2668875899 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Virginia Commonwealth University, School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sentara Medical GroupGroup PAC ID 8921903923, 1,396 clinicians

Practice addresses (Care Compare)

5320 Providence Rd
Suite 301
Virginia Beach, VA 23464-4122
Phone (757) 413-7900

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Pinnacle Health Medical Services Family Medicine Current Accepting new patients
Pinnacle Health Medical Services CurrentSince Jul 21, 2021 Accepting new patients
Pinnacle Health Medical Services CurrentSince Jul 21, 2021 Accepting new patients
Sentara Medical Group Family Medicine CurrentSince Jul 8, 2023 Accepting new patients

Locations

5400 Chambers Hill Rd
Harrisburg, PA 17111
Phone (717) 564-5400

2501 N 3rd St
Fl 2
Harrisburg, PA 17110
Phone (717) 782-2100

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

5320 Providence Rd
Ste 301
Virginia Beach, VA 23464
Phone (757) 413-7600

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1525132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684195200000",
    "number": "1104314509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5320 PROVIDENCE RD STE 301",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234644122",
            "telephone_number": "757-413-7600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5320 PROVIDENCE RD STE 301",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234644122",
            "telephone_number": "757-413-7600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEAK",
        "first_name": "TIERRA",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-01",
        "last_updated": "2023-05-16",
        "certification_date": "2023-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD474955",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101278323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tleak205578@phsdirect.pinnaclehealth.org",
            "affiliation": "N",
            "address_1": "5400 Chambers Hill Rd",
            "city": "Harrisburg",
            "state": "PA",
            "country_code": "US",
            "postal_code": "171112545",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

Verify at the official NPI Registry.