Individual provider Active NPI

Fegan H. Richmond, PT, DPT

  • Physical Therapist
  • Richmond, VA
National Provider Identifier
1235484197
Registry record updated Jan 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2305207510 Issued in VA
Practice address
4831 S Laburnum Ave
Richmond, VA 23231-2713
Phone
(804) 222-0745
Fax
(804) 222-0748
NPI assigned
Jul 17, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2305207510 VA Primary

Addresses

Primary practice location

4831 S Laburnum Ave
Richmond, VA 23231-2713

Mailing address

2122 York Rd Ste 300
Oak Brook, IL 60523-1925
Phone (630) 575-6200

Other identifiers 3

IdentifierTypeStateIssuer
P01406467OtherVAMEDICARE RR PTAN
1235484197MedicaidVA
C05954OtherVAMEDICARE GROUP PTAN

Other names 1

  • Fegan M. Hewitt Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120824000665 VA Practitioner - Physical Therapist in Private Practice 0143477281 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tidewater Physical Therapy LLCGroup PAC ID 6406759281, 225 clinicians

Practice addresses (Care Compare)

4831 S Laburnum Ave
Richmond, VA 23231-2713
Phone (804) 222-0726

Merit-based Incentive Payment System (MIPS)

Final score
88.16 of 100Reported as group
Quality
85.78
Promoting interoperability
99
Improvement activities
40
Cost
75.6

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2305207510VAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Tidewater Physical Therapy, LLC Physical Therapist Current Accepting new patients
Tidewater Physical Therapy, LLC Physical Therapist CurrentSince Jul 23, 2012 Accepting new patients
Tidewater Physical Therapy, LLC Physical Therapist CurrentSince Jul 23, 2012 Accepting new patients
Tidewater Physical Therapy LLC Physical Therapist Past Accepting new patients
Tidewater Physical Therapy LLC Physical Therapist Past Accepting new patients
Tidewater Physical Therapy LLC Physical Therapist Past Accepting new patients
Tidewater Physical Therapy, LLC Physical Therapist Past Accepting new patients
Tidewater Physical Therapy LLC Physical Therapist Past Accepting new patients
Tidewater Physical Therapy, LLC Physical Therapist Past Accepting new patients

Locations

2122 York Rd
Ste 300
Oak Brook, IL 60523
Phone (630) 575-6250

10128 W Broad St
Bldg Iii
Glen Allen, VA 23060
Phone (804) 217-9210

771 Pilot House Dr
#A
Newport News, VA 23606
Phone (757) 873-2302

4831 S Laburnum Ave
Richmond, VA 23231
Phone (800) 422-2074

Organizations & group practices 9

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": "1342483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736899200000",
    "number": "1235484197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2122 YORK RD STE 300",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231925",
            "telephone_number": "630-575-6200",
            "fax_number": "410-648-4878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4831 S LABURNUM AVE",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232312713",
            "telephone_number": "804-222-0745",
            "fax_number": "804-222-0748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHMOND",
        "first_name": "FEGAN",
        "middle_name": "H.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-17",
        "last_updated": "2025-01-15",
        "certification_date": "2025-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305207510",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR PTAN",
            "identifier": "P01406467",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235484197",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "C05954",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "FEGAN",
            "last_name": "HEWITT",
            "middle_name": "M.",
            "credential": "PT, DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Richmond, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.