NPIMap

Organization Active NPI

Neurology Consulants of Tidewater PLLC

Doing business as Virginia Beach Neurology

  • Specialist
  • Virginia Beach, VA
National Provider Identifier
1154496776
Registry record updated May 27, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
0101052447 Issued in VA
Legal business name
NEUROLOGY CONSULANTS OF TIDEWATER PLLC
Doing business as
Virginia Beach Neurology
Practice address
968 First Colonial Rd
Suite 103
Virginia Beach, VA 23454-3171
Phone
(757) 481-3808
NPI assigned
Nov 21, 2006
Last updated
May 27, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2009

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

Authorized official

Name
Andrea J Glover
Title
Credentialing
Phone
(757) 481-3808

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 0101052447 VA Primary

Addresses

Primary practice location

968 First Colonial Rd
Suite 103
Virginia Beach, VA 23454-3171

Mailing address

968 First Colonial Rd
Suite 103
Virginia Beach, VA 23454-3171
Phone (757) 481-3808

Other names 1

  • Virginia Beach Neurology Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040422001307 VA Part B Supplier - Clinic/Group Practice 9739175928 Receives reassigned benefits from 11 practitioners
2 other NPIs on this enrollment
Practice locations: Norfolk, VA

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

6161 Kempsville Cir
Ste 315
Norfolk, VA 23502
Phone (757) 461-5400

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243382400000",
    "number": "1154496776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "968 FIRST COLONIAL RD",
            "address_2": "SUITE 103",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234543171",
            "telephone_number": "757-481-3808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "968 FIRST COLONIAL RD",
            "address_2": "SUITE 103",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234543171",
            "telephone_number": "757-481-3808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROLOGY CONSULANTS OF TIDEWATER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-21",
        "last_updated": "2009-05-27",
        "status": "A",
        "authorized_official_last_name": "GLOVER",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "757-481-3808"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "VA",
            "license": "0101052447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Virginia Beach Neurology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Virginia Beach, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.