NPIMap

Organization Active NPI

Tidewater Orthopaedic Associates Inc

  • Specialist
  • Suffolk, VA
National Provider Identifier
1629629340
Registry record updated Apr 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
TIDEWATER ORTHOPAEDIC ASSOCIATES INC
Practice address
7007 Harbour View Blvd Ste 108
Suffolk, VA 23435-3657
Phone
(757) 827-2480
Fax
(757) 827-2566
NPI assigned
Sep 24, 2019
Last updated
Apr 5, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
TIDEWATER ORTHOPAEDIC ASSOCIATES INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 5, 2024

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

Authorized official

Name
Stacey Tanner Bell
Title
Ceo
Phone
(757) 827-2480

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X Primary
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

7007 Harbour View Blvd Ste 108
Suffolk, VA 23435-3657

Mailing address

901 Enterprise Pkwy Ste 900
Hampton, VA 23666-6250
Phone (757) 827-2480

Other practice location 1

3920A Bridge Rd Ste 305
Suffolk, VA 23435-1126
Phone (757) 827-2480

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250423003378 VA DME Supplier - Physician - General PracticeDME Supplier - Independently-Practicing Physical TherapistDME Supplier - Independently-Practicing Occupational Therapist 2466345814 Practice locations: Suffolk, VA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
Tidewater Orthoped Asso

Locations

3920A Bridge Rd
Ste 305
Suffolk, VA 23435
Phone (757) 251-2971

4037 Ironbound Rd
Williamsburg, VA 23188
Phone (757) 206-1004

5208 Monticello Ave
Ste 180
Williamsburg, VA 23188
Phone (757) 206-1004

Practitioners & affiliated clinicians

Practitioners 36

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 36

NPI Registry JSON

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

{
    "created_epoch": "1569283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712275200000",
    "number": "1629629340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 ENTERPRISE PKWY STE 900",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236666250",
            "telephone_number": "757-827-2480",
            "fax_number": "757-299-9917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7007 HARBOUR VIEW BLVD STE 108",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234353657",
            "telephone_number": "757-827-2480",
            "fax_number": "757-827-2566"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3920A Bridge Rd Ste 305",
            "address_purpose": "LOCATION",
            "city": "Suffolk",
            "state": "VA",
            "postal_code": "234351126",
            "country_code": "US",
            "telephone_number": "757-827-2480",
            "fax_number": "757-299-9917",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TIDEWATER ORTHOPAEDIC ASSOCIATES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TIDEWATER ORTHOPAEDIC ASSOCIATES INC",
        "enumeration_date": "2019-09-24",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A",
        "authorized_official_last_name": "BELL",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "TANNER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "757-827-2480"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Suffolk, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 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.