Individual provider Active NPI

Christopher J. Ciccone, M.D.

  • Family Medicine Physician
  • Williamsburg, VA
National Provider Identifier
1659377356
Registry record updated Mar 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101052863 Issued in VA
Practice address
4125 Ironbound Rd
Suite 200
Williamsburg, VA 23188-2666
Phone
(757) 345-2829
Fax
(757) 345-0644
NPI assigned
Jun 27, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0101052863 VA Primary

Addresses

Primary practice location

4125 Ironbound Rd
Suite 200
Williamsburg, VA 23188-2666

Mailing address

860 Omni Blvd Ste 101
Newport News, VA 23606-4430
Phone (757) 232-8769

Other identifiers 2

IdentifierTypeStateIssuer
080091377OtherVARAILROAD MEDICARE
5626072MedicaidVA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address christopher.ciccone.p1@direct.tpmg.nextgenshare.com Direct

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100327000620 VA Practitioner - Family Practice 5698801777 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Eastern Virginia Medical School, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tidewater Physicians Multispecialty Group, PCGroup PAC ID 2860398526, 259 clinicians

Practice addresses (Care Compare)

13347 Warwick Blvd
Newport News, VA 23602-5601
Phone (757) 877-0214

4125 Ironbound Rd
Suite 200
Williamsburg, VA 23188-2666
Phone (757) 345-2829

860 Omni Blvd
Newport News, VA 23606-4430

Hospital & facility affiliations

  • Bayada Home Health Care - Yorktown Home health agency, Yorktown, VA, CCN 497607
  • Sentara Home Care Services-Williamsburg Home health agency, Williamsburg, VA, CCN 497748
  • Commonwealth Home Care Home health agency, Portsmouth, VA, CCN 497775
  • Riverside Regional Medical Center Hospital, Newport News, VA, CCN 490052
  • Sentara Williamsburg Regional Medical Center Hospital, Williamsburg, VA, CCN 490066
  • Riverside Walter Reed Hospital Hospital, Gloucester, VA, CCN 490130
  • Sentara Careplex Hospital Hospital, Hampton, VA, CCN 490093
  • Mary Immaculate Hospital Hospital, Newport News, VA, CCN 490041

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101052863VAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tidewater Physicians Multispecialty Group PC CurrentSince Apr 22, 1997 Accepting new patients
Tidewater Physicians Multispecialty Group PC Family Medicine CurrentSince Apr 22, 1997 Accepting new patients

Locations

860 Omni Blvd
Ste 101
Newport News, VA 23606
Phone (757) 223-9794

729 Thimble Shoals Blvd
Newport News, VA 23606
Phone (757) 874-1077

13347 Warwick Blvd
Newport News, VA 23602
Phone (757) 877-0214

860 Omni Blvd
Ste 303
Newport News, VA 23606
Phone (757) 232-8777

860 Omni Blvd
Newport News, VA 23606
Phone (757) 369-8138

827 Diligence Dr
Ste 100
Newport News, VA 23606

4125 Ironbound Rd
Ste 200
Williamsburg, VA 23188
Phone (757) 345-2829

Interoperability endpoints

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

Organizations & group practices 2

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 8

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": "1119830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616544000000",
    "number": "1659377356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "860 OMNI BLVD STE 101",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236064430",
            "telephone_number": "757-232-8769",
            "fax_number": "757-232-8875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4125 IRONBOUND RD",
            "address_2": "SUITE 200",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231882666",
            "telephone_number": "757-345-2829",
            "fax_number": "757-345-0644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CICCONE",
        "first_name": "CHRISTOPHER",
        "middle_name": "J.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-27",
        "last_updated": "2021-03-24",
        "certification_date": "2021-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101052863",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080091377",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5626072",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "christopher.ciccone.p1@direct.tpmg.nextgenshare.com",
            "affiliation": "N",
            "endpointDescription": "nextgen",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "network",
            "address_1": "4125 Ironbound Rd",
            "address_2": "Suite 200",
            "city": "Williamsburg",
            "state": "VA",
            "country_code": "US",
            "postal_code": "231882666",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Williamsburg, VA

Sources for this page

Verify at the official NPI Registry.