NPIMap

Individual provider Active NPI

Nicole Faye Yeshtokin, DO

  • Surgery Physician
  • South Boston, VA
National Provider Identifier
1336371525
Registry record updated Jun 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
0102203996 Issued in VA
Practice address
22232 Wilborn Ave Ste C
South Boston, VA 24592-1662
Phone
(434) 517-3910
Fax
(434) 517-3912
NPI assigned
Aug 20, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 2020-04156 NC
Surgery Physician 208600000X 0T013281 PA
Surgery Physician 208600000X 0102203996 VA Primary

Addresses

Primary practice location

22232 Wilborn Ave Ste C
South Boston, VA 24592-1662

Mailing address

2232 Wilborn Ave Ste C
South Boston, VA 24592-1662
Phone (434) 517-3910

Other practice location 1

1177 N Road St
Elizabeth City, NC 27909-3388
Phone (252) 337-9440

Other practice location 2

106 Fairview Dr Ste A
Franklin, VA 23851
Phone (757) 562-6181

Other names 1

  • Nicole Desimone Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180212000147 VA Practitioner - General Surgery 3870726631 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of New England, College of Osteo Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bon Secours Medical Group Hampton Roads Specialty Care LLCGroup PAC ID 3173955671, 197 clinicians

Practice addresses (Care Compare)

150 Kingsley LN
Norfolk, VA 23505-4602
Phone (757) 398-2673

2 Bernadine Dr
Newport News, VA 23602-4404
Phone (757) 947-3838

3636 High St
Portsmouth, VA 23707-3236
Phone (757) 398-2222

5818 Harbour View Blvd
Suffolk, VA 23435-3315

5838 Harbour View Blvd
Suffolk, VA 23435-2663

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)19
Hernia repair (minimally invasive)1-10
Mastectomy36
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Melanoma (skin cancer) excision1-10
Removal of tissue24
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0T013281PAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mary Immaculate Hospital LLC Surgery CurrentSince May 1, 2021 Accepting new patients
Mary Immaculate Hospital LLC CurrentSince May 1, 2021 Accepting new patients
Bon Secours Medical Group Hampton Roads Specialty Care LLC CurrentSince Jan 1, 2020 Accepting new patients
Dominion Health Medical Assoc CurrentSince Jul 31, 2023 Accepting new patients
Dominion Health Medical Assoc. CurrentSince Jul 31, 2023 Accepting new patients
Bon Secours Medical Group Hampton Roads Specialty Care LLC Surgery CurrentSince Jan 1, 2020 Accepting new patients

Locations

100 Fairview Dr
Franklin, VA 23851
Phone (757) 516-1153

106 Fairview Dr
Ste A
Franklin, VA 23851
Phone (757) 562-6181

12720 McManus Blvd
Ste 308
Newport News, VA 23602
Phone (757) 947-3170

12720 McManus Blvd
Ste 305
Newport News, VA 23602
Phone (757) 947-3170

155 Kingsley Ln
Ste 405
Norfolk, VA 23505
Phone (757) 278-2220

150 Kingsley Ln
Norfolk, VA 23505
Phone (757) 464-6944

8580 Magellan Pkwy
Richmond, VA 23227
Phone (804) 627-5462

2232 Wilborn Ave
Ste F
South Boston, VA 24592
Phone (434) 517-8095

2232 Wilborn Ave
Ste C
South Boston, VA 24592
Phone (434) 517-3910

5838 Harbour View Blvd
Ste 240
Suffolk, VA 23435
Phone (757) 278-2220

Interoperability endpoints

  • Direct secure messaging: nyeshtokin1157082@direct.bsmhealth.org
  • Direct secure messaging: ndesimone427810@direct.sentara.net

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1250726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719532800000",
    "number": "1336371525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2232 WILBORN AVE STE C",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245921662",
            "telephone_number": "434-517-3910",
            "fax_number": "434-517-3912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22232 WILBORN AVE STE C",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245921662",
            "telephone_number": "434-517-3910",
            "fax_number": "434-517-3912"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1177 N Road St",
            "address_purpose": "LOCATION",
            "city": "Elizabeth City",
            "state": "NC",
            "postal_code": "279093388",
            "country_code": "US",
            "telephone_number": "252-337-9440",
            "fax_number": "225-384-9997",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "106 Fairview Dr Ste A",
            "address_purpose": "LOCATION",
            "city": "Franklin",
            "state": "VA",
            "postal_code": "23851",
            "country_code": "US",
            "telephone_number": "757-562-6181",
            "fax_number": "757-569-7553",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YESHTOKIN",
        "first_name": "NICOLE",
        "middle_name": "FAYE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-20",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NC",
            "license": "2020-04156",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "0T013281",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "VA",
            "license": "0102203996",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "DESIMONE",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in South Boston, VA

Sources for this page

Verify at the official NPI Registry.