Individual provider Active NPI

Jason Channing Coleman, MD

  • Pediatrics Physician
  • Linchburg, VA
National Provider Identifier
1578633301
Registry record updated Jul 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
0101237294 Issued in VA
Practice address
2323 Memorial Ave Suite 10
Linchburg, VA 24501
Phone
(434) 517-8022
NPI assigned
Nov 9, 2006
Last updated
Jul 19, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 0101237294 VA Primary

Addresses

Primary practice location

2323 Memorial Ave Suite 10
Linchburg, VA 24501

Mailing address

2323 Memorial Ave Suite 10
Linchburg, VA 24501
Phone (434) 517-8022

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, MD2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20161011001741 VA Practitioner - Pediatric Medicine 0042508830 Reassigns benefits to 1 organization
I20231122000053 MD Practitioner - Pediatric Medicine 0042508830 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101237294VAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tidalhealth Primary Care, LLC CurrentSince Dec 4, 2023 Accepting new patients
Dominion Health Medical Assoc. Current Accepting new patients
Dominion Health Medical Assoc CurrentSince Oct 1, 2016 Accepting new patients
Dominion Health Medical Assoc Pediatrics CurrentSince Oct 1, 2016 Accepting new patients

Locations

100 E Carroll St
Salisbury, MD 21801
Phone (410) 543-7100

1639 Woodbrooke Dr
Salisbury, MD 21804
Phone (410) 543-7475

400 Eastern Shore Dr
Salisbury, MD 21804
Phone (410) 543-2255

2100 Wilborn Ave
South Boston, VA 24592
Phone (434) 517-8022

2232 Wilborn Ave
Ste F
South Boston, VA 24592
Phone (434) 517-8095

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626652800000",
    "number": "1578633301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2323 MEMORIAL AVE SUITE 10",
            "city": "LINCHBURG",
            "state": "VA",
            "postal_code": "24501",
            "telephone_number": "434-517-8022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2323 MEMORIAL AVE SUITE 10",
            "city": "LINCHBURG",
            "state": "VA",
            "postal_code": "24501",
            "telephone_number": "434-517-8022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLEMAN",
        "first_name": "JASON",
        "middle_name": "CHANNING",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-09",
        "last_updated": "2021-07-19",
        "certification_date": "2021-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101237294",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Sources for this page

Verify at the official NPI Registry.