Monique Brock, PA
Individual provider Active NPI Physician Assistant · Chesapeake, VA
NPI 1285945733 · NPPES record last updated Jun 20, 2024
Key facts
- NPI
- 1285945733
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 0110003318 (VA)
- Practice address
- 648 Grassfield Pkwy Ste 1
Chesapeake, VA 23322-7465 - Phone
- (757) 312-6797
- Fax
- (757) 410-0390
- NPI assigned
- Jun 30, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100803000432 | VA | Practitioner - Physician Assistant | 2860525425 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0110003318 | VA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bayview Physician Services, PC | Current |
Accepting new patients | |
| Bayview Physician Services, PC | Current |
Accepting new patients | |
| Chesapeake Regional Medical Group | Current |
Accepting new patients | |
| Chesapeake Regional Medical Group | Physician Assistant | Current |
Accepting new patients |
| Atlantic Care Associates PC | Past | Accepting new patients |
Locations
648 Grassfield Pkwy
Ste 1
Chesapeake, VA 23322
Phone (757) 312-6797
667 Kingsborough Sq
Ste 101
Chesapeake, VA 23320
Phone (757) 312-3132
111 Mill Creek Pkwy
Chesapeake, VA 23323
Phone (757) 558-8210
300 Medical Pkwy
Chesapeake, VA 23320
Phone (757) 312-6102
400 W Brambleton Ave
Ste 201
Norfolk, VA 23510
Phone (757) 623-3800
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0110003318 | VA | Yes |
Addresses
Primary practice location
648 Grassfield Pkwy Ste 1
Chesapeake, VA 23322-7465
Mailing address
667 Kingsborough SQ Ste 101
Chesapeake, VA 23320-4999
Phone (757) 842-4481
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285945733 | Other | VA | OPTIMA |
| 1285945733 | Medicaid | VA | |
| 1285945733 | Other | VA | TRICARE |
Other providers in Chesapeake, VA
- Emily Kristen Britt
- Essence Britt
- Mitzi Britt
- Bethany Shannon Brittain
- Francis Lane Brittan Jr.
- Katherine Wingate Brooks
- Kelly C. Brooks
- Megan Kelsey Brooks
- Sheila Brooks
- Brown Family Services LLC
All providers in Chesapeake, VA · Physician Assistant in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.