NPIMap

Individual provider Active NPI

Madhu K Kolli, MD

  • Nephrology Physician
  • Virginia Beach, VA
National Provider Identifier
1114900552
Registry record updated Jan 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
0101232981 Issued in VA
Practice address
828 Healthy Way Ste 270
Virginia Beach, VA 23462-7959
Phone
(757) 623-0005
Fax
(757) 389-5383
NPI assigned
Nov 21, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0101232981 VA
Nephrology Physician 207RN0300X 0101232981 VA Primary

Addresses

Primary practice location

828 Healthy Way Ste 270
Virginia Beach, VA 23462-7959

Mailing address

4445 Corporation LN Ste 100
Virginia Beach, VA 23462-3666
Phone (757) 623-0005

Other identifiers 2

IdentifierTypeStateIssuer
103251OtherVABLUE CROSS BLUE SHEILD
005875889MedicaidVA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110307000901 VA Practitioner - NephrologyPractitioner - Internal Medicine 1850313958 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Tidewater Kidney Specialists IncGroup PAC ID 6507852662, 21 clinicians

Practice addresses (Care Compare)

828 Healthy Way
Suite 270
Virginia Beach, VA 23462-7959
Phone (757) 623-0005

Hospital & facility affiliations

  • DaVita Virginia Beach Dialysis Center Dialysis facility, Virginia Beach, VA, CCN 492575
  • DaVita Tidewater Home Dialysis Dialysis facility, Virginia Beach, VA, CCN 492669
  • Sentara Princess Anne Hospital Hospital, Virginia Beach, VA, CCN 490119
  • Sentara Virginia Beach General Hospital Hospital, Virginia Beach, VA, CCN 490057
  • Sentara Leigh Hospital Hospital, Norfolk, VA, CCN 490046
  • Sentara Norfolk General Hospital Hospital, Norfolk, VA, CCN 490007
  • Chesapeake General Hospital Hospital, Chesapeake, VA, CCN 490120

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Tidewater Kidney Specialists, Inc. Nephrology CurrentSince Sep 1, 2002 Accepting new patients
Tidewater Kidney Specialists, Inc. Nephrology CurrentSince Sep 1, 2002 Accepting new patients

Locations

814 Kempsville Rd
Ste 102
Norfolk, VA 23502

301 Riverview Ave
Ste 512
Norfolk, VA 23510
Phone (757) 627-5116

4445 Corporation Ln
Ste 100
Virginia Beach, VA 23462

828 Healthy Way
Ste 270
Virginia Beach, VA 23462

4560 South Blvd
Ste 202
Virginia Beach, VA 23452
Phone (757) 340-6100

Interoperability endpoints

  • Direct secure messaging: madhukolli@tks.allscriptsdirect.net

Organizations & group practices 2

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 10

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": "1132531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642636800000",
    "number": "1114900552",
    "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": "828 HEALTHY WAY STE 270",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234627959",
            "telephone_number": "757-623-0005",
            "fax_number": "757-389-5383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLLI",
        "first_name": "MADHU",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-21",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101232981",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "VA",
            "license": "0101232981",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHEILD",
            "identifier": "103251",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005875889",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

Verify at the official NPI Registry.