NPIMap

Individual provider Active NPI

Jean Khara Casillan, MD

  • Family Medicine Physician
  • Virginia Beach, VA
National Provider Identifier
1629522172
Registry record updated Jun 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101275998 Issued in VA
Practice address
1168 First Colonial Rd Ste 200
Virginia Beach, VA 23454-2444
Phone
(757) 352-2020
Fax
(757) 352-2021
NPI assigned
Aug 12, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 57544 AZ
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 0101275998 VA Primary

Addresses

Primary practice location

1168 First Colonial Rd Ste 200
Virginia Beach, VA 23454-2444

Mailing address

3241 Western Branch Blvd Ste a
Chesapeake, VA 23321-5260
Phone (757) 686-3508

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221014002912 VA Practitioner - Family Practice 8224323571 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2012
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)

1168 1St Colonial Rd
Virginia Beach, VA 23454-2426
Phone (757) 352-2020

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101275998VAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bayview Physician Services, PC Family Medicine CurrentSince Oct 1, 2022 Accepting new patients
District Medical Group, Inc Current Accepting new patients
District Medical Group, Inc CurrentSince Aug 21, 2019 Accepting new patients
Bayview Physician Services, PC CurrentSince Oct 1, 2022 Accepting new patients
District Medical Group, Inc CurrentSince Aug 21, 2019 Accepting new patients
Bayview Medical Center, Inc PastSince Jun 4, 2023 Accepting new patients
Bayview Physician Services, PC PastSince Jun 4, 2023 Accepting new patients
District Medical Group, Inc Family Medicine Past Accepting new patients

Locations

8088 W Whitney Dr
Peoria, AZ 85345
Phone (602) 655-2000

2929 E Thomas Rd
Phoenix, AZ 85016
Phone (602) 470-5043

3141 N 3rd Ave
Phoenix, AZ 85013
Phone (602) 914-1520

2525 E Roosevelt St
Phoenix, AZ 85008
Phone (602) 344-1015

2601 E Roosevelt St
Phoenix, AZ 85008
Phone (602) 220-0298

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 200
Virginia Beach, VA 23454
Phone (757) 496-9020

1168 First Colonial Rd
Virginia Beach, VA 23454
Phone (757) 352-2020

Interoperability endpoints

  • Direct secure messaging: jean.casillan@bayview.eclinicaldirectplus.com
  • Direct secure messaging: jcasillangonzales211580@direct.valleywisehealth.org

Organizations & group practices 8

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 11

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": "1470960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685577600000",
    "number": "1629522172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3241 WESTERN BRANCH BLVD STE A",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233215260",
            "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": "1168 FIRST COLONIAL RD STE 200",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234542444",
            "telephone_number": "757-352-2020",
            "fax_number": "757-352-2021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CASILLAN",
        "first_name": "JEAN KHARA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-12",
        "last_updated": "2023-06-01",
        "certification_date": "2023-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "57544",
            "primary": false
        },
        {
            "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": "0101275998",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

Verify at the official NPI Registry.