Individual provider Active NPI

Luis F. Olmedo, MD

  • Pediatrics Physician
  • Chesapeake, VA
National Provider Identifier
1114922077
Registry record updated Jul 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
0101255330 Issued in VA
Practice address
817 Volvo Pkwy
Chesapeake, VA 23320-2855
Phone
(757) 668-4630
NPI assigned
Jun 16, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 27, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 6155 PR
Pediatric Adolescent Medicine Physician 2080A0000X 6155 PR
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X 0101255330 VA
Pediatrics Physician 208000000X 0101255330 VA Primary

Addresses

Primary practice location

817 Volvo Pkwy
Chesapeake, VA 23320-2855

Mailing address

817 Volvo Pkwy
Chesapeake, VA 23320-2855
Phone (757) 668-4630

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
I20150623002031 VA Practitioner - Pediatric Medicine 2769793314 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6155PRMDPediatrics Physician
0101255330VAMDPediatric Emergency Medicine (Pediatrics) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Childrens Specialty Group PLLC Pediatrics CurrentSince Aug 17, 2015 Accepting new patients
Childrens Hospital of the Kings Daughters Inc CurrentSince Apr 4, 2015 Accepting new patients

Locations

817 Volvo Pkwy
Chesapeake, VA 23320
Phone (757) 668-4630

601 Childrens Ln
Norfolk, VA 23507
Phone (757) 668-7272

3960 Virginia Beach Blvd
Ste 101
Virginia Beach, VA 23452
Phone (757) 668-4648

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.

NPI Registry JSON

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

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690416000000",
    "number": "1114922077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "817 VOLVO PKWY",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233202855",
            "telephone_number": "757-668-4630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "817 VOLVO PKWY",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233202855",
            "telephone_number": "757-668-4630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLMEDO",
        "first_name": "LUIS",
        "middle_name": "F.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-16",
        "last_updated": "2023-07-27",
        "certification_date": "2023-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PR",
            "license": "6155",
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "PR",
            "license": "6155",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "VA",
            "license": "0101255330",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101255330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesapeake, VA

Sources for this page

Verify at the official NPI Registry.