NPIMap

Organization Active NPI

Tidewater Neurologists Inc, PC

  • Neurology Physician
  • Portsmouth, VA
National Provider Identifier
1689623258
Registry record updated Oct 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
TIDEWATER NEUROLOGISTS INC, PC
Practice address
3235 Academy Ave
Suite 305
Portsmouth, VA 23703-3200
Phone
(757) 686-9300
Fax
(757) 686-1514
NPI assigned
May 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2023

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

Authorized official

Name
Dr. Hemang H Shah, MDNPI 1982654042
Title
Owner
Phone
(757) 686-9300

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084N0400X Primary
Clinical Neurophysiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084N0600X

Addresses

Primary practice location

3235 Academy Ave
Suite 305
Portsmouth, VA 23703-3200

Mailing address

3235 Academy Ave Ste 305
Portsmouth, VA 23703-3200
Phone (757) 463-5240

Other identifiers 1

IdentifierTypeStateIssuer
200250OtherVASENTARA

Other names 1

  • Tidewater Neurologists and Sleep Disorder Specialist, inc Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060329000783 VA Part B Supplier - Clinic/Group Practice 4688682875 Receives reassigned benefits from 6 practitioners
Practice locations: Chesapeake, VA; Virginia Beach, VA; Portsmouth, VA; Hampton, VA

National Provider Directory

National Provider Directory

Locations

300 Medical Pkwy
Ste 108
Chesapeake, VA 23320
Phone (757) 547-5805

2713 Neil Armstrong Pkwy
#G3
Hampton, VA 23666
Phone (757) 262-0390

2713 Neil Armstrong Pkwy
Hampton, VA 23666

2713 Neil Armstrong Pkwy
Ste G3
Hampton, VA 23666
Phone (757) 262-0390

3235 Academy Ave
Ste 305
Portsmouth, VA 23703
Phone (757) 686-3000

2876 Guardian Ln
Virginia Beach, VA 23452
Phone (757) 463-5240

Practitioners & affiliated clinicians

Practitioners 11

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": "1147132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698624000000",
    "number": "1689623258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3235 ACADEMY AVE STE 305",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237033200",
            "telephone_number": "757-463-5240",
            "fax_number": "757-463-6572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3235 ACADEMY AVE",
            "address_2": "SUITE 305",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237033200",
            "telephone_number": "757-686-9300",
            "fax_number": "757-686-1514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER NEUROLOGISTS INC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-09",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "HEMANG",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "757-686-9300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084N0600X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SENTARA",
            "identifier": "200250",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tidewater Neurologists and Sleep Disorder Specialist, inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portsmouth, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2023; 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.