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Individual provider Active NPI

Beverly Lavern Roberts-Atwater, DO PHD

  • Physical Medicine & Rehabilitation Physician
  • Norfolk, VA
National Provider Identifier
1245237791
Registry record updated Sep 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
0102202910 Issued in VA
Practice address
721 Fairfax Ave
3Rd Floor
Norfolk, VA 23507-2007
Phone
(757) 446-5915
Fax
(757) 446-5969
NPI assigned
Jun 30, 2005
Last updated
Sep 15, 2014By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 15, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 0102202910 VA Primary

Addresses

Primary practice location

721 Fairfax Ave
3Rd Floor
Norfolk, VA 23507-2007

Mailing address

PO Box 936
Norfolk, VA 23501-0936
Phone (757) 446-5915

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
I20120105000757 VA Practitioner - Physical Medicine and Rehabilitation 3173426285 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Michigan State University College of Osteopathic Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

721 Fairfax Ave
Norfolk, VA 23507-2007
Phone (757) 446-5915

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
0102202910VAMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Evms Academic Physicians and Surgeons Health Services Foundation Physical Medicine & Rehabilitation CurrentSince Jan 1, 2012 Accepting new patients
Midwest Physician Services PC Past Accepting new patients
HCR Manorcare Medical Services of Florida LLC Physical Medicine & Rehabilitation Past Accepting new patients
Quality Healthcare of Northeast Ohio Inc Physical Medicine & Rehabilitation Past Accepting new patients

Locations

600 Gresham Dr
Norfolk, VA 23507
Phone (757) 473-0055

721 Fairfax Ave
Norfolk, VA 23507
Phone (757) 446-5955

721 Fairfax Ave
Fl 3
Norfolk, VA 23507
Phone (757) 446-5915

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lake Taylor Transitional Care HospitalNorfolk, VA, CCN 492001 Hospital Corporate Director Aug 17, 2012
Lake Taylor Transitional Care HospitalNorfolk, VA, CCN 495117 Skilled nursing facility Corporate Director (9%)
Operational/Managerial Control
Managing Control - Governing Body		 Aug 17, 2012
Aug 17, 2012
Aug 17, 2012

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

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 8

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

NPI Registry JSON

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410739200000",
    "number": "1245237791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 936",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235010936",
            "telephone_number": "757-446-5915",
            "fax_number": "757-446-5969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 FAIRFAX AVE",
            "address_2": "3RD FLOOR",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235072007",
            "telephone_number": "757-446-5915",
            "fax_number": "757-446-5969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS-ATWATER",
        "first_name": "BEVERLY",
        "middle_name": "LAVERN",
        "credential": "DO PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-06-30",
        "last_updated": "2014-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "VA",
            "license": "0102202910",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norfolk, VA

Sources for this page

Verify at the official NPI Registry.