Individual provider Active NPI

Brian R Port, MD

  • Family Medicine Physician
  • Chester, VA
National Provider Identifier
1336133602
Registry record updated Jan 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101033236 Issued in VA
Practice address
12801 Iron Bridge Rd
Suite 200
Chester, VA 23831-1669
Phone
(804) 748-9071
Fax
(804) 768-8626
NPI assigned
Sep 1, 2005
Last updated
Jan 11, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0101-033236 VA
Family Medicine Physician 207Q00000X 0101033236 VA Primary

Addresses

Primary practice location

12801 Iron Bridge Rd
Suite 200
Chester, VA 23831-1669

Mailing address

12801 Iron Bridge Rd
Suite 200
Chester, VA 23831-1669
Phone (804) 748-9071

Other practice location 1

2760 Godwin Blvd Ste 100
Suffolk, VA 23434-8501
Phone (757) 983-8650

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, SC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080812000696 VA Practitioner - Family Practice 0143395087 Reassigns benefits to 2 organizations
I20170315000863 SC Practitioner - Family Practice 0143395087 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Albany Medical College of Union University, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MCV Associated PhysiciansGroup PAC ID 4385542117, 1,779 clinicians

Practice addresses (Care Compare)

300 Mt Clement Park
Tappahannock, VA 22560-5098
Phone (804) 443-6063

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0101033236VAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sentara Medical Group Family Medicine CurrentSince Feb 1, 2021 Accepting new patients
MCV Associated Physicians Family Medicine CurrentSince Oct 25, 2022 Accepting new patients
Allendale County Hospital Board Family Medicine Current Accepting new patients

Locations

1787 Allendale Fairfax Hwy
Fairfax, SC 29827
Phone (803) 632-3311

850 Kempsville Rd
Norfolk, VA 23502
Phone (757) 261-0162

401 N 11th St
Richmond, VA 23219
Phone (804) 828-4409

2760 Godwin Blvd
Ste 100
Suffolk, VA 23434
Phone (757) 983-8650

300 Mt Clement Park
Tappahannock, VA 22560
Phone (804) 443-6063

16 Delfae Dr
Warsaw, VA 22572
Phone (804) 333-1260

Organizations & group practices 3

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 5

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": "1125532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610323200000",
    "number": "1336133602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12801 IRON BRIDGE RD",
            "address_2": "SUITE 200",
            "city": "CHESTER",
            "state": "VA",
            "postal_code": "238311669",
            "telephone_number": "804-748-9071",
            "fax_number": "804-768-8626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12801 IRON BRIDGE RD",
            "address_2": "SUITE 200",
            "city": "CHESTER",
            "state": "VA",
            "postal_code": "238311669",
            "telephone_number": "804-748-9071",
            "fax_number": "804-768-8626"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2760 Godwin Blvd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Suffolk",
            "state": "VA",
            "postal_code": "234348501",
            "country_code": "US",
            "telephone_number": "757-983-8650",
            "fax_number": "757-983-8673",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PORT",
        "first_name": "BRIAN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-01",
        "last_updated": "2021-01-11",
        "certification_date": "2021-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101-033236",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101033236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chester, VA

Sources for this page

Verify at the official NPI Registry.