Individual provider Active NPI

Stephanie Ann Moody Antonio, MD

  • Otology & Neurotology Physician
  • Norfolk, VA
National Provider Identifier
1366418956
Registry record updated Jan 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otology & Neurotology PhysicianTaxonomy code 207YX0901X
License
0101237385 Issued in VA
Practice address
600 Gresham Dr
Suite 1100
Norfolk, VA 23507-1904
Phone
(757) 388-6200
Fax
(757) 388-6201
NPI assigned
Feb 24, 2006
Last updated
Jan 26, 2009By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 0101237385 VA
Otology & Neurotology Physician 207YX0901X 0101237385 VA Primary

Addresses

Primary practice location

600 Gresham Dr
Suite 1100
Norfolk, VA 23507-1904

Mailing address

PO Box 936
Norfolk, VA 23501-0936
Phone (757) 388-6200

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
I20050119000353 VA Practitioner - Otolaryngology 9638128499 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Indiana University School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Childrens Specialty Group PLLCGroup PAC ID 5890788764, 89 clinicians

Practice addresses (Care Compare)

600 Gresham Dr
Norfolk, VA 23507-1904
Phone (757) 388-6200

601 Childre's LN
Norfolk, VA 23507-1910
Phone (757) 668-7007

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101237385VAMDOtology & Neurotology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Evms Academic Physicians and Surgeons Health Services Foundation Otolaryngology CurrentSince Feb 1, 2005 Accepting new patients
Childrens Specialty Group PLLC CurrentSince Sep 28, 2010 Accepting new patients

Locations

500 Discovery Dr
Chesapeake, VA 23320
Phone (757) 668-2311

11783 Rock Landing Dr
Newport News, VA 23606
Phone (757) 668-6550

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

600 Gresham Dr
Ste 1100
Norfolk, VA 23507
Phone (757) 388-6200

601 Childrens Ln
Norfolk, VA 23507
Phone (757) 668-7272

6261 E Virginia Beach Blvd
Ste 200
Norfolk, VA 23502
Phone (757) 625-4455

2021 Concert Dr
Virginia Beach, VA 23456
Phone (757) 668-6550

2075 Glenn Mitchell Dr
Ste 310
Virginia Beach, VA 23456
Phone (757) 689-8500

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 6

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": "1140739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1232928000000",
    "number": "1366418956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 936",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235010936",
            "telephone_number": "757-388-6200",
            "fax_number": "757-388-6201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 GRESHAM DR",
            "address_2": "SUITE 1100",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071904",
            "telephone_number": "757-388-6200",
            "fax_number": "757-388-6201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOODY ANTONIO",
        "first_name": "STEPHANIE",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-24",
        "last_updated": "2009-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "VA",
            "license": "0101237385",
            "primary": false
        },
        {
            "code": "207YX0901X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otology & Neurotology",
            "state": "VA",
            "license": "0101237385",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norfolk, VA

Sources for this page

Verify at the official NPI Registry.