Individual provider Active NPI

Kimberly Mary Span, MD

  • Internal Medicine Physician
  • Norfolk, VA
National Provider Identifier
1336302454
Registry record updated Oct 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
0101246307 Issued in VA
Practice address
825 Fairfax Ave
Suite 445
Norfolk, VA 23507-1914
Phone
(757) 446-8920
Fax
(757) 446-5242
NPI assigned
Jul 9, 2008
Last updated
Oct 30, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0101246307 VA Primary
Hospitalist Physician 208M00000X 0101246307 VA

Addresses

Primary practice location

825 Fairfax Ave
Suite 445
Norfolk, VA 23507-1914

Mailing address

1060 First Colonial Rd
Virginia Beach, VA 23454-3002
Phone (757) 395-2323

Other identifiers 14

IdentifierTypeStateIssuer
-028OtherVATRICARE/CHAMPUS
422982OtherVAANTHEM BC/BS
PAROtherVAUSA MANAGED CARE
1336302454MedicaidVA
PAROtherVACORVEL/CORCARE
PAROtherVACIGNA
PAROtherVAAETNA
5916953MedicaidNC
PAROtherVAVIRGINIA HEALTH NETWORK
PAROtherVAVIRGINIA PREMIER HEALTH PLAN
1336302454OtherVAFIRST HEALTH NETWORK/COVENTRY HEALTH
10071693OtherVASENTARA/OPTIMA HEALTH
PAROtherVAMULTIPLAN
PAROtherVAUNITED HEALTHCARE

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100917000205 VA Practitioner - Internal Medicine 8022133743 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Eastern Virginia Medical School, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sentara Medical GroupGroup PAC ID 8921903923, 1,396 clinicians

Practice addresses (Care Compare)

1060 1St Colonial Rd
1St
Virginia Beach, VA 23454-3002
Phone (757) 395-6116

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sentara Medical Group Internal Medicine CurrentSince Jan 23, 2016 Accepting new patients
Virginia Hospitalists Inc Internal Medicine Past Accepting new patients

Locations

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

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

1060 First Colonial Rd
Virginia Beach, VA 23454
Phone (757) 395-2323

Organizations & group practices 2

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 1

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": "1215561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730246400000",
    "number": "1336302454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1060 FIRST COLONIAL RD",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234543002",
            "telephone_number": "757-395-2323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 FAIRFAX AVE",
            "address_2": "SUITE 445",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071914",
            "telephone_number": "757-446-8920",
            "fax_number": "757-446-5242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPAN",
        "first_name": "KIMBERLY",
        "middle_name": "MARY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-09",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101246307",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "VA",
            "license": "0101246307",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE/CHAMPUS",
            "identifier": "-028",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS",
            "identifier": "422982",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "USA MANAGED CARE",
            "identifier": "PAR",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1336302454",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CORVEL/CORCARE",
            "identifier": "PAR",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "PAR",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "PAR",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5916953",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VIRGINIA HEALTH NETWORK",
            "identifier": "PAR",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VIRGINIA PREMIER HEALTH PLAN",
            "identifier": "PAR",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH NETWORK/COVENTRY HEALTH",
            "identifier": "1336302454",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SENTARA/OPTIMA HEALTH",
            "identifier": "10071693",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MULTIPLAN",
            "identifier": "PAR",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "PAR",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norfolk, VA

Sources for this page

Verify at the official NPI Registry.