NPIMap

Individual provider Active NPI

Maciej Stanislaw Tobola, MD

  • Diagnostic Radiology Physician
  • Norfolk, VA
National Provider Identifier
1154559805
Registry record updated Jun 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
0101258213 Issued in VA
Practice address
110 Kingsley LN Ste 305
Norfolk, VA 23505-4617
Phone
(757) 889-5422
Fax
(757) 889-5450
NPI assigned
Jul 1, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 19, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 4301094374 MI
Diagnostic Radiology Physician 2085R0202X 0101258213 VA Primary

Addresses

Primary practice location

110 Kingsley LN Ste 305
Norfolk, VA 23505-4617

Mailing address

110 Kingsley LN Ste 305
Norfolk, VA 23505-4617
Phone (757) 889-5422

Other identifiers 1

IdentifierTypeStateIssuer
1154559805MedicaidVA

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
I20150806009850 VA Practitioner - Diagnostic Radiology 4688897325 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hampton Roads Radiology Associates, PCGroup PAC ID 4880688506, 39 clinicians

Practice addresses (Care Compare)

582 Lynnhaven Pkwy
Suite 301
Virginia Beach, VA 23452-7386
Phone (757) 916-9630

Hospital & facility affiliations

  • Sentara Obici Hospital Hospital, Suffolk, VA, CCN 490044
  • Sentara Virginia Beach General Hospital Hospital, Virginia Beach, VA, CCN 490057
  • Sentara Princess Anne Hospital Hospital, Virginia Beach, VA, CCN 490119
  • Bon Secours Maryview Medical Center Hospital, Portsmouth, VA, CCN 490017
  • Sentara Norfolk General Hospital Hospital, Norfolk, VA, CCN 490007

Merit-based Incentive Payment System (MIPS)

Final score
93.4 of 100Reported as group
Quality
100
Improvement activities
40
Cost
77.98

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301094374MIMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hampton Roads Radiology Associates, PC Diagnostic Radiology CurrentSince Jul 1, 2015 Accepting new patients
Kingsley Lane Anatomic Pathology Current Accepting new patients

Locations

150 Kingsley Ln
Norfolk, VA 23505
Phone (757) 464-6944

582 Lynnhaven Pkwy
Ste 301
Virginia Beach, VA 23452
Phone (757) 916-9631

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 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1246406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560902400000",
    "number": "1154559805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 KINGSLEY LN STE 305",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235054617",
            "telephone_number": "757-889-5422",
            "fax_number": "757-889-5450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 KINGSLEY LN STE 305",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235054617",
            "telephone_number": "757-889-5422",
            "fax_number": "757-889-5450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOBOLA",
        "first_name": "MACIEJ",
        "middle_name": "STANISLAW",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-07-01",
        "last_updated": "2019-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "4301094374",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "VA",
            "license": "0101258213",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1154559805",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norfolk, VA

Sources for this page

Verify at the official NPI Registry.