Individual provider Active NPI

Braxton Reid Wilkinson

  • Physician Assistant
  • Virginia Beach, VA
National Provider Identifier
1558130997
Registry record updated Sep 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110010251 Issued in VA
Practice address
1060 First Colonial Rd
Virginia Beach, VA 23454-3002
Phone
(757) 967-8622
Fax
(757) 686-0541
NPI assigned
Dec 27, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 6, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0110010251 VA Primary

Addresses

Primary practice location

1060 First Colonial Rd
Virginia Beach, VA 23454-3002

Mailing address

3241 Western Branch Blvd
Chesapeake, VA 23321-5260
Phone (757) 967-8622

Other practice location 1

736 Battlefield Blvd N
Chesapeake, VA 23320-4941
Phone (757) 967-8622

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240912002202 VA Practitioner - Physician Assistant 7416497730 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Eastern Virginia Medical School, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bayview Physician Services PCGroup PAC ID 5597664201, 311 clinicians

Practice addresses (Care Compare)

111 Mill Creek Pkwy
Suite 300
Chesapeake, VA 23323-1098
Phone (757) 558-8210

Hospital & facility affiliations

  • Sentara Virginia Beach General Hospital Hospital, Virginia Beach, VA, CCN 490057

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0110010251VAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Bayview Physician Services, PC CurrentSince Sep 1, 2024 Accepting new patients
Bayview Physician Services, PC CurrentSince Sep 1, 2024 Accepting new patients
Bayview Medical Center, Inc Past Accepting new patients

Locations

3241 Western Branch Blvd
Ste A
Chesapeake, VA 23321

111 Mill Creek Pkwy
Chesapeake, VA 23323
Phone (757) 558-8210

3241 Western Branch Blvd
Chesapeake, VA 23321
Phone (757) 686-3500

1168 First Colonial Rd
Ste 101
Virginia Beach, VA 23454
Phone (757) 481-2515

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 1

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": "1703635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725580800000",
    "number": "1558130997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3241 WESTERN BRANCH BLVD",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233215260",
            "telephone_number": "757-967-8622",
            "fax_number": "757-686-0541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 FIRST COLONIAL RD",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234543002",
            "telephone_number": "757-967-8622",
            "fax_number": "757-686-0541"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "736 Battlefield Blvd N",
            "address_purpose": "LOCATION",
            "city": "Chesapeake",
            "state": "VA",
            "postal_code": "233204941",
            "country_code": "US",
            "telephone_number": "757-967-8622",
            "fax_number": "757-686-0541",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILKINSON",
        "first_name": "BRAXTON",
        "middle_name": "REID",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-12-27",
        "last_updated": "2024-09-06",
        "certification_date": "2024-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110010251",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

Verify at the official NPI Registry.