Ailene D Medalla, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0101264734 Issued in VA

Practice address

725 Volvo Pkwy Ste 100
Chesapeake, VA 23320

Phone

(757) 548-0076

Fax

(757) 548-1652

NPI assigned

Apr 7, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Ailene Dumo Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Bayview Medical Center, Inc

  • Ambulatory Surgical Clinic/Center
  • Suffolk, VA
  • NPI 1568466209
  NPD (past)

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

{
    "created_epoch": "1428364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531267200000",
    "number": "1508252461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7068",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237070068",
            "telephone_number": "757-686-3508",
            "fax_number": "757-686-0541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 VOLVO PKWY STE 100",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "23320",
            "telephone_number": "757-548-0076",
            "fax_number": "757-548-1652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDALLA",
        "first_name": "AILENE",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-04-07",
        "last_updated": "2018-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101264734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AILENE",
            "last_name": "DUMO",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Franklin D. Meadows, LCSW
• Jonathan David Meadows, P.A.
• Mecca Care LLC
• Med MGT Associates of Virginia LLC
• Med Systems Associates
• Medease Medical Transportation
• Medease Medical Transportation
• Medi Home Health Agency, Inc.
• Medi Home Health Agency, Inc.
• Medical & Surgical Eye Specialists Inc

• Family Medicine Physician in Chesapeake, VA
• Providers in Chesapeake, 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 Jul 11, 2018; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.