NPIMap

Individual provider Active NPI

Khusbuben Shantilal Patel, MD

  • Family Medicine Physician
  • Chesapeake, VA
National Provider Identifier
1215593082
Registry record updated Sep 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101276311 Issued in VA
Practice address
4124 Chesapeake Square Blvd Ste 103
Chesapeake, VA 23321-2134
Phone
(757) 983-5100
Fax
(757) 673-8292
NPI assigned
May 16, 2019
Last updated
Sep 28, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Family Medicine Physician 207Q00000X 0101276311 VA Primary

Addresses

Primary practice location

4124 Chesapeake Square Blvd Ste 103
Chesapeake, VA 23321-2134

Mailing address

4124 Chesapeake Square Blvd Ste 103
Chesapeake, VA 23321
Phone (757) 983-5100

Other names 1

  • Khusbuben S Patel Other name

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
I20221115000070 VA Practitioner - Family Practice 5395077564 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sentara Medical GroupGroup PAC ID 8921903923, 1,396 clinicians

Practice addresses (Care Compare)

4124 Chesapeake SQ Blvd
Suite 103
Chesapeake, VA 23321-2000
Phone (757) 983-5100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101276311VAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sentara Medical Group Family Medicine CurrentSince Sep 26, 2022 Accepting new patients
Sentara Medical Group PastSince Sep 26, 2022 Accepting new patients

Locations

850 Kempsville Rd
Norfolk, VA 23502
Phone (757) 261-0162

Interoperability endpoints

  • Direct secure messaging: kpatel771600@direct.sentara.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1557964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695859200000",
    "number": "1215593082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4124 CHESAPEAKE SQUARE BLVD STE 103",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "23321",
            "telephone_number": "757-983-5100",
            "fax_number": "757-673-8292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4124 CHESAPEAKE SQUARE BLVD STE 103",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233212134",
            "telephone_number": "757-983-5100",
            "fax_number": "757-673-8292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "KHUSBUBEN",
        "middle_name": "SHANTILAL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-16",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101276311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KHUSBUBEN",
            "last_name": "PATEL",
            "middle_name": "S",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Chesapeake, VA

Sources for this page

Verify at the official NPI Registry.