Individual provider Active NPI

Kevin M. Hesse, P.T.

  • Physical Therapist
  • Chesapeake, VA
National Provider Identifier
1104819812
Registry record updated Apr 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2305210751 Issued in VA
Practice address
4020 Raintree Rd
Suite D
Chesapeake, VA 23321-3749
Phone
(757) 484-4241
Fax
(757) 484-4487
NPI assigned
Aug 27, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 017353-1 NY
Physical Therapist 225100000X 2305210751 VA Primary

Addresses

Primary practice location

4020 Raintree Rd
Suite D
Chesapeake, VA 23321-3749

Mailing address

PO Box 69030
Baltimore, MD 21264-0930
Phone (757) 873-2302

Other identifiers 3

IdentifierTypeStateIssuer
C05954OtherVAGROUP MEDICARE PTAN
1104819812MedicaidVA
Q56530AOtherMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
017353-1NYMDPhysical Therapist
2305210751VAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Fusion Chiropractic, LLC CurrentSince Jun 3, 2019 Accepting new patients
Tidewater Physical Therapy LLC Physical Therapist Past Accepting new patients
Tidewater Physical Therapy, LLC Physical Therapist Past Accepting new patients
Tidewater Physical Therapy, LLC Physical Therapist Past Accepting new patients
Tidewater Physical Therapy LLC Physical Therapist Past Accepting new patients
Sports Physical Therapy of New York, P.C. Physical Therapist Past Accepting new patients
All in One Specialty Health LLC Physical Therapist PastSince Jun 7, 2021 Accepting new patients
Tidewater Physical Therapy LLC Physical Therapist Past Accepting new patients

Locations

109 Bulifants Blvd
Ste B
Williamsburg, VA 23188
Phone (757) 229-9740

201 Bulifants Blvd
Ste B
Williamsburg, VA 23188
Phone (757) 229-9740

5388 Discovery Park Blvd
Ste 200
Williamsburg, VA 23188

5388 Discovery Park Blvd
Ste 100
Williamsburg, VA 23188
Phone (757) 707-3955

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1125100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523836800000",
    "number": "1104819812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 69030",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212640930",
            "telephone_number": "757-873-2302",
            "fax_number": "757-873-2306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4020 RAINTREE RD",
            "address_2": "SUITE D",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233213749",
            "telephone_number": "757-484-4241",
            "fax_number": "757-484-4487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HESSE",
        "first_name": "KEVIN",
        "middle_name": "M.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-27",
        "last_updated": "2018-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "017353-1",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305210751",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICARE PTAN",
            "identifier": "C05954",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1104819812",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "Q56530A",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesapeake, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.