NPIMap

Organization Active NPI

Tidewater Allergy and Asthma LLC

  • Allergy & Immunology Physician
  • Virginia Beach, VA
National Provider Identifier
1629889308
Registry record updated Apr 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy & Immunology PhysicianTaxonomy code 207K00000X
Legal business name
TIDEWATER ALLERGY AND ASTHMA LLC
Practice address
4534 Bonney Rd Ste B
Virginia Beach, VA 23462-3873
Phone
(757) 499-4101
Fax
(757) 497-2419
NPI assigned
Jan 14, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2025

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

Authorized official

Name
Dr. Jeremy Ray Owens, MDNPI 1740743053
Title
Owner
Phone
(757) 572-6052

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207K00000X Primary

Addresses

Primary practice location

4534 Bonney Rd Ste B
Virginia Beach, VA 23462-3873

Mailing address

1828 Duke of Norfolk Quay
Virginia Beach, VA 23454-1106

Other practice location 1

516 Innovation Dr Ste 306
Chesapeake, VA 23320-3866
Phone (757) 499-4101

Other names 1

  • Tidewater Allery and Asthma Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250303002885 VA Part B Supplier - Clinic/Group Practice 3476074774 Receives reassigned benefits from 2 practitioners
Practice locations: Virginia Beach, VA; Chesapeake, VA

National Provider Directory

National Provider Directory

Locations

516 Innovation Dr
Ste 306
Chesapeake, VA 23320
Phone (757) 499-4101

4534 Bonney Rd
Ste B
Virginia Beach, VA 23462
Phone (757) 494-4101

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GFHIDD

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1736812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743638400000",
    "number": "1629889308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1828 DUKE OF NORFOLK QUAY",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234541106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4534 BONNEY RD STE B",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234623873",
            "telephone_number": "757-499-4101",
            "fax_number": "757-497-2419"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "516 Innovation Dr Ste 306",
            "address_purpose": "LOCATION",
            "city": "Chesapeake",
            "state": "VA",
            "postal_code": "233203866",
            "country_code": "US",
            "telephone_number": "757-499-4101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TIDEWATER ALLERGY AND ASTHMA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-14",
        "last_updated": "2025-04-03",
        "certification_date": "2025-04-03",
        "status": "A",
        "authorized_official_last_name": "OWENS",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "757-572-6052",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Allergy & Immunology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tidewater Allery and Asthma",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tidewater Allery and Asthma",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Virginia Beach, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2025; 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.