Active NPI
Daniel Wayne Davis
- Physician Assistant
- Virginia Beach, VA
National Provider Identifier
1255677332
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1108099
- Practice address
- 1035 Nider Blvd
Suite 100
Virginia Beach, VA 23459 - Phone
- (757) 953-8155
- NPI assigned
- Dec 18, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1108099 | Primary |
Addresses
Primary practice location
1035 Nider Blvd
Suite 100
Virginia Beach, VA 23459
Mailing address
1035 Nider Blvd
Suite 100
Virginia Beach, VA 23459
Phone (757) 953-8153
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130508000157 | VA | Order and Referring Only - Physician Assistant | 2769629906 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1355788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1355788800000",
"number": "1255677332",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1035 NIDER BLVD",
"address_2": "SUITE 100",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "23459",
"telephone_number": "757-953-8153"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1035 NIDER BLVD",
"address_2": "SUITE 100",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "23459",
"telephone_number": "757-953-8155"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "DANIEL",
"middle_name": "WAYNE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-12-18",
"last_updated": "2012-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": "1108099",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Virginia Beach, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.