NPIMap

Organization Active NPI

Childrens Medical Group Inc

Doing business as Tidewater Children's Associates

  • Pediatrics Physician
  • Norfolk, VA
National Provider Identifier
1538214713
Registry record updated Feb 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
CHILDRENS MEDICAL GROUP INC
Doing business as
Tidewater Children's Associates
Practice address
171 Kempsville Rd
BLDG B
Norfolk, VA 23502-4700
Phone
(757) 668-6500
Fax
(757) 668-6506
NPI assigned
Jan 25, 2007
Last updated
Feb 26, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
CHILDRENS MEDICAL GROUP INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 26, 2024

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

Authorized official

Name
Kathryn J Abshire
Title
Senior VP/Cfo
Phone
(757) 668-8565

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X Primary

Addresses

Primary practice location

171 Kempsville Rd
BLDG B
Norfolk, VA 23502-4700

Mailing address

601 Childrens LN
Norfolk, VA 23507-1910
Phone (757) 668-7017

Other practice location 1

601 Innovation Dr Ste A
Chesapeake, VA 23320-3869
Phone (757) 668-2650

Other practice location 2

5835 Harbour View Blvd Ste B
Suffolk, VA 23435-2601
Phone (757) 668-6050

Other names 1

  • Tidewater Children's Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120426000044 VA Part B Supplier - Clinic/Group Practice 2769487594 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Norfolk, VA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
CMG Ta Pediatric Diag GRP

Locations

601 Innovation Dr
Chesapeake, VA 23320
Phone (757) 668-2650

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708905600000",
    "number": "1538214713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 CHILDRENS LN",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071910",
            "telephone_number": "757-668-7017",
            "fax_number": "757-668-8929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 KEMPSVILLE RD",
            "address_2": "BLDG B",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235024700",
            "telephone_number": "757-668-6500",
            "fax_number": "757-668-6506"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 Innovation Dr Ste A",
            "address_purpose": "LOCATION",
            "city": "Chesapeake",
            "state": "VA",
            "postal_code": "233203869",
            "country_code": "US",
            "telephone_number": "757-668-2650",
            "fax_number": "757-668-2655",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5835 Harbour View Blvd Ste B",
            "address_purpose": "LOCATION",
            "city": "Suffolk",
            "state": "VA",
            "postal_code": "234352601",
            "country_code": "US",
            "telephone_number": "757-668-6050",
            "fax_number": "757-668-6055",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CHILDRENS MEDICAL GROUP INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHILDRENS MEDICAL GROUP INC",
        "enumeration_date": "2007-01-25",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A",
        "authorized_official_last_name": "ABSHIRE",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SENIOR VP/CFO",
        "authorized_official_telephone_number": "757-668-8565"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tidewater Children's Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tidewater Children's Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Norfolk, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.