NPIMap

Organization Active NPI

Bluestone Physician Services Southeast LLC

  • Family Medicine Physician
  • Norfolk, VA
National Provider Identifier
1255945739
Registry record updated Oct 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BLUESTONE PHYSICIAN SERVICES SOUTHEAST LLC
Practice address
999 Waterside Dr Ste 2525
Norfolk, VA 23510-3316
Phone
(757) 777-3433
Fax
(855) 818-3907
NPI assigned
Sep 2, 2020
Last updated
Oct 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2020

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

Authorized official

Name
Tim Koehler
Title
Coo
Phone
(651) 342-1039

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary
General Practice Physician 208D00000X

Addresses

Primary practice location

999 Waterside Dr Ste 2525
Norfolk, VA 23510-3316

Mailing address

270 Main St N Ste 300
Stillwater, MN 55082-6788
Phone (651) 342-1039

Other names 1

  • Bluestone Physician Services Florida, LLC Former legal business name

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

270 Main St N
Ste 300
Stillwater, MN 55082
Phone (651) 342-1039

Practitioners & affiliated clinicians

Practitioners 29

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 29

NPI Registry JSON

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

{
    "created_epoch": "1599004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603324800000",
    "number": "1255945739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "270 MAIN ST N STE 300",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550826788",
            "telephone_number": "651-342-1039",
            "fax_number": "651-342-1428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "999 WATERSIDE DR STE 2525",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235103316",
            "telephone_number": "757-777-3433",
            "fax_number": "855-818-3907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUESTONE PHYSICIAN SERVICES SOUTHEAST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-02",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A",
        "authorized_official_last_name": "KOEHLER",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "651-342-1039"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bluestone Physician Services Florida, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Norfolk, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.