Individual provider Active NPI

Jana Nussen, MD

  • Family Medicine Physician
  • Hampton, VA
National Provider Identifier
1528004371
Registry record updated Dec 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101237740 Issued in VA
Practice address
2205 Executive Dr Ste a
Hampton, VA 23666-2948
Phone
(757) 825-4273
Fax
(757) 825-4276
NPI assigned
Jun 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2019

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 0101237740 VA Primary

Addresses

Primary practice location

2205 Executive Dr Ste a
Hampton, VA 23666-2948

Mailing address

860 Omni Blvd Ste 101
Newport News, VA 23606-4430
Phone (757) 232-8769

Other identifiers 4

IdentifierTypeStateIssuer
010203538MedicaidVA
96723OtherSENTARA
180680OtherVABCBS
180680OtherVAHKEEPER

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
I20050811000525 VA Practitioner - Family Practice 0244269082 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Eastern Virginia Medical School, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

2115 Executive Dr
5D
Hampton, VA 23666-2451
Phone (757) 223-4992

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Tidewater Physicians Multispecialty Group PC CurrentSince Jan 1, 2013 Accepting new patients
Tidewater Physicians Multispecialty Group PC Family Medicine CurrentSince Jan 1, 2013 Accepting new patients
Family Practice of Hampton Roads Family Medicine Past Accepting new patients

Locations

2205 Executive Dr
Ste D
Hampton, VA 23666
Phone (757) 825-4273

2205 Executive Dr
Ste A
Hampton, VA 23666
Phone (757) 223-4992

2115 Executive Dr
#5D
Hampton, VA 23666
Phone (757) 223-4992

2117 Hartford Rd
Ste C
Hampton, VA 23666
Phone (757) 825-4273

2117 Hartford Rd
Hampton, VA 23666
Phone (757) 722-7401

704 Thimble Shoals Blvd
#30
Newport News, VA 23606
Phone (757) 595-4300

860 Omni Blvd
Ste 101
Newport News, VA 23606
Phone (757) 223-9794

729 Thimble Shoals Blvd
Newport News, VA 23606
Phone (757) 874-1077

827 Diligence Dr
Ste 100
Newport News, VA 23606

860 Omni Blvd
Ste 303
Newport News, VA 23606
Phone (757) 232-8777

860 Omni Blvd
Newport News, VA 23606
Phone (757) 369-8138

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BGFHDD

Organizations & group practices 3

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.

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": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576713600000",
    "number": "1528004371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "860 OMNI BLVD STE 101",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236064430",
            "telephone_number": "757-232-8769",
            "fax_number": "757-232-8875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2205 EXECUTIVE DR STE A",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236662948",
            "telephone_number": "757-825-4273",
            "fax_number": "757-825-4276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NUSSEN",
        "first_name": "JANA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-21",
        "last_updated": "2019-12-19",
        "certification_date": "2019-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101237740",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010203538",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SENTARA",
            "identifier": "96723",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "180680",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HKEEPER",
            "identifier": "180680",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hampton, VA

Sources for this page

Verify at the official NPI Registry.