Gautam D Desai, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0101045379 Issued in VA

Practice address

2020 S Independence Blvd
Suite #3
Virginia Beach, VA 23453

Phone

(757) 471-6977

Fax

(757) 471-5300

NPI assigned

Oct 16, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277337600000",
    "number": "1417047663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 S INDEPENDENCE BLVD",
            "address_2": "SUITE #3",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "23453",
            "telephone_number": "757-471-6977",
            "fax_number": "757-471-5300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 S INDEPENDENCE BLVD",
            "address_2": "SUITE #3",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "23453",
            "telephone_number": "757-471-6977",
            "fax_number": "757-471-5300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESAI",
        "first_name": "GAUTAM",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-16",
        "last_updated": "2010-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101045379",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "080100260",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005628881",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "332419",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Derek D. Russell, D.C., Inc.
• Jamie Lauren Dermatis, DPM
• Dermatology Inc. of Virginia Beach
• Derrick M. Broadaway, D.D.S., PC
• Michele Valenti Derwent
• Saaransh Rakesh Desai, MD
• Heather Deschaine
• Suhas L Deshmukh, M.D.
• Desire Haven LLC
• Renee Lea Desjarlais, M.S., CCC-SLP

• Family Medicine Physician in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Family Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.