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Organization Active NPI

Tidewater Orthopaedic Associates Inc

  • Orthopaedic Surgery Physician
  • Hampton, VA
National Provider Identifier
1225058548
Registry record updated Mar 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
78013 Issued in VA
Legal business name
TIDEWATER ORTHOPAEDIC ASSOCIATES INC
Practice address
901 Enterprise Pkwy Ste 900
Hampton, VA 23666-6250
Phone
(757) 827-2480
Fax
(757) 827-2566
NPI assigned
Jul 20, 2006
Last updated
Mar 22, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2024

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

Authorized official

Name
Stacey Tanner Bell
Title
Ceo
Phone
(757) 827-2480

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X
Occupational Medicine Clinic/Center 261QX0100X
Durable Medical Equipment & Medical Supplies 332B00000X
Orthopaedic Surgery Physician 207X00000X 78013 VA Primary

Addresses

Primary practice location

901 Enterprise Pkwy Ste 900
Hampton, VA 23666-6250

Mailing address

901 Enterprise Parkway
Suite 900
Hampton, VA 23666
Phone (757) 827-2480

Other practice location 1

4037 Ironbound Rd
Williamsburg, VA 23188-2507
Phone (757) 206-1004

Other practice location 2

3920A Bridge Rd Ste 305
Suffolk, VA 23435-1126
Phone (757) 251-2971 ext. 75728

Other practice location 3

7007 Harbour View Blvd Ste 108
Suffolk, VA 23435-3657
Phone (757) 827-2480

Other identifiers 10

IdentifierTypeStateIssuer
3001514667-0005MedicaidVA
371277300OtherUS DEPT OF LABOR GROUP#
CF1964OtherMEDICARE RR GROUP NUMBER
3001514667-0004MedicaidVA
500002OtherVASENTARA VENDER NUMBER
3001514667-0001MedicaidVA
453382OtherVAANTHEM GROUP NUMBER
463139OtherVAANTHEM PT GROUP NUMBER
192680OtherVAANTHEM OT GROUP#
64835OtherVASENTARA THERAPY GROUP#

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040207000398 VA Part B Supplier - Clinic/Group Practice 2466345814 Receives reassigned benefits from 33 practitioners
Practice locations: Suffolk, VA; Williamsburg, VA; Hampton, VA
O20111012000681 VA DME Supplier - Multi-Specialty - PhysicianDME Supplier - Other 2466345814 Practice locations: Hampton, VA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

901 Enterprise Pkwy
Ste 900
Hampton, VA 23666
Phone (757) 827-2480

4037 Ironbound Rd
Williamsburg, VA 23188
Phone (757) 206-1004

5208 Monticello Ave
Ste 180
Williamsburg, VA 23188
Phone (757) 206-1004

Practitioners & affiliated clinicians

Practitioners 34

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 34

NPI Registry JSON

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711065600000",
    "number": "1225058548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 ENTERPRISE PARKWAY",
            "address_2": "SUITE 900",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "23666",
            "telephone_number": "757-827-2480",
            "fax_number": "757-282-5848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 ENTERPRISE PKWY STE 900",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236666250",
            "telephone_number": "757-827-2480",
            "fax_number": "757-827-2566"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4037 Ironbound Rd",
            "address_purpose": "LOCATION",
            "city": "Williamsburg",
            "state": "VA",
            "postal_code": "231882507",
            "country_code": "US",
            "telephone_number": "757-206-1004",
            "fax_number": "757-645-3965",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3920A Bridge Rd Ste 305",
            "address_purpose": "LOCATION",
            "city": "Suffolk",
            "state": "VA",
            "postal_code": "234351126",
            "country_code": "US",
            "telephone_number": "757-251-2971 x75728",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7007 Harbour View Blvd Ste 108",
            "address_purpose": "LOCATION",
            "city": "Suffolk",
            "state": "VA",
            "postal_code": "234353657",
            "country_code": "US",
            "telephone_number": "757-827-2480",
            "fax_number": "757-827-2566",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TIDEWATER ORTHOPAEDIC ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-20",
        "last_updated": "2024-03-22",
        "certification_date": "2024-03-22",
        "status": "A",
        "authorized_official_last_name": "BELL",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "TANNER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "757-827-2480"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "VA",
            "license": "78013",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3001514667-0005",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPT OF LABOR GROUP#",
            "identifier": "371277300",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR GROUP NUMBER",
            "identifier": "CF1964",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3001514667-0004",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SENTARA VENDER NUMBER",
            "identifier": "500002",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3001514667-0001",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM GROUP NUMBER",
            "identifier": "453382",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PT GROUP NUMBER",
            "identifier": "463139",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM OT GROUP#",
            "identifier": "192680",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SENTARA THERAPY GROUP#",
            "identifier": "64835",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hampton, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2024; 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.