NPIMap

Individual provider Active NPI

Xiao Hong Jin, MD

  • Family Medicine Physician
  • Petersburg, VA
National Provider Identifier
1679766752
Registry record updated Dec 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101243767 Issued in VA
Practice address
15 Goodrich Ave
Petersburg, VA 23805-2119
Phone
(804) 732-0618
Fax
(804) 861-6846
NPI assigned
Aug 22, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 001714 GA
Family Medicine Physician 207Q00000X 0101243767 VA Primary

Addresses

Primary practice location

15 Goodrich Ave
Petersburg, VA 23805-2119

Mailing address

15 Goodrich Ave
Petersburg, VA 23805-2119
Phone (804) 732-0618

Other identifiers 2

IdentifierTypeStateIssuer
1679766752MedicaidVA
P00722723OtherVARAILROAD MEDICARE

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
I20090224000267 VA Practitioner - Family PracticePractitioner - Hospitalist 9739247529 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Hospitalist
Education
Other, 1985
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

15 Coodrich Ave
Petersburg, VA 23805-2119
Phone (804) 732-0618

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
001714GAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Health Urgentone, Inc. Family Medicine Past Accepting new patients
Arnot Medical Services PLLC Family Medicine Past Accepting new patients
Midlothian Rehabilitation Associates PLLC PastSince Dec 29, 2016 Accepting new patients
Inpatient Medical Services, P.a. Past Accepting new patients

Organizations & group practices 5

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 19

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1187740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672185600000",
    "number": "1679766752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 GOODRICH AVE",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238052119",
            "telephone_number": "804-732-0618",
            "fax_number": "804-861-6846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 GOODRICH AVE",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238052119",
            "telephone_number": "804-732-0618",
            "fax_number": "804-861-6846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIN",
        "first_name": "XIAO",
        "middle_name": "HONG",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-22",
        "last_updated": "2022-12-28",
        "certification_date": "2022-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "001714",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101243767",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679766752",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00722723",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Petersburg, VA

Sources for this page

Verify at the official NPI Registry.