NPIMap

Individual provider Active NPI

James Mitchell Waddy Jr., M.D.

  • Family Medicine Physician
  • Suffolk, VA
National Provider Identifier
1487603205
Registry record updated Nov 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
101232080 Issued in VA
Practice address
3920 A Bridge Rd
Suffolk, VA 23435
Phone
(757) 983-2200
Fax
(757) 275-9993
NPI assigned
May 9, 2006
Last updated
Nov 17, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 101232080 VA Primary

Addresses

Primary practice location

3920 A Bridge Rd
Suffolk, VA 23435

Mailing address

3920 A Bridge Rd
Suffolk, VA 23435
Phone (757) 983-2200

Other identifiers 1

IdentifierTypeStateIssuer
10048052MedicaidVA

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
I20061117000192 VA Practitioner - Family Practice 8426056961 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Virginia Commonwealth University, School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sentara Medical GroupGroup PAC ID 8921903923, 1,396 clinicians

Practice addresses (Care Compare)

3920 A Bridge Rd
Suite 202
Suffolk, VA 23435-1107
Phone (757) 736-3725

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
101232080VAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sentara Medical Group Family Medicine CurrentSince Oct 1, 2006 Accepting new patients

Locations

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

919 S Church St
Smithfield, VA 23430
Phone (757) 357-3291

3920A Bridge Rd
Ste 202
Suffolk, VA 23435
Phone (757) 736-3725

3920A Bridge Rd
Ste 207
Suffolk, VA 23435
Phone (757) 925-0759

Interoperability endpoints

  • Direct secure messaging: jwaddy16194@direct.sentara.net

Organizations & group practices 1

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 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321488000000",
    "number": "1487603205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3920 A BRIDGE RD",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "23435",
            "telephone_number": "757-983-2200",
            "fax_number": "757-275-9993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3920 A BRIDGE RD",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "23435",
            "telephone_number": "757-983-2200",
            "fax_number": "757-275-9993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADDY",
        "first_name": "JAMES",
        "middle_name": "MITCHELL",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-09",
        "last_updated": "2011-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "101232080",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10048052",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Suffolk, VA

Sources for this page

Verify at the official NPI Registry.