NPIMap

Individual provider Active NPI

Lydia Willis White, PA-C

  • Physician Assistant
  • Suffolk, VA
National Provider Identifier
1396455937
Registry record updated Dec 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110009295 Issued in VA
Practice address
5838 Harbour View Blvd Ste 100
Suffolk, VA 23435-2663
Phone
(757) 673-5680
Fax
(757) 483-3075
NPI assigned
Dec 5, 2022
Last updated
Dec 17, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0110009295 VA Primary

Addresses

Primary practice location

5838 Harbour View Blvd Ste 100
Suffolk, VA 23435-2663

Mailing address

PO Box 639971
Cincinnati, OH 45263-9971

Other names 1

  • Lydia Willis 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
I20231121003902 VA Practitioner - Physician Assistant 8820446321 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Eastern Virginia Medical School, 2023
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)

1040 University Blvd
Portsmouth, VA 23703-2650

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

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

930 W 21St St
Norfolk, VA 23517-1516

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0110009295VAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Bon Secours Medical Group Hampton Roads Specialty Care LLC CurrentSince Oct 8, 2023 Accepting new patients
Bon Secours Medical Group Hampton Roads Specialty Care LLC CurrentSince Oct 8, 2023 Accepting new patients

Locations

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

5838 Harbour View Blvd
Ste 100
Suffolk, VA 23435
Phone (757) 483-0407

Interoperability endpoints

  • Direct secure messaging: lwillis2405108@direct.bsmhealth.org

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 11

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": "1670198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765929600000",
    "number": "1396455937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 639971",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452639971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5838 HARBOUR VIEW BLVD STE 100",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234352663",
            "telephone_number": "757-673-5680",
            "fax_number": "757-483-3075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "LYDIA",
        "middle_name": "WILLIS",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-12-05",
        "last_updated": "2025-12-17",
        "certification_date": "2025-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110009295",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LYDIA",
            "last_name": "WILLIS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Suffolk, VA

Sources for this page

Verify at the official NPI Registry.