Individual provider Active NPI

Makenzie Slone Bennington-Winslow

  • Physician Assistant
  • Norfolk, VA
National Provider Identifier
1740090273
Registry record updated Sep 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110011308 Issued in VA
Practice address
825 Fairfax Ave
Norfolk, VA 23507-1914
Phone
(757) 446-5600
NPI assigned
Jan 8, 2025
Last updated
Sep 4, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 4, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0110011308 VA Primary

Addresses

Primary practice location

825 Fairfax Ave
Norfolk, VA 23507-1914

Mailing address

825 Fairfax Ave
Norfolk, VA 23507-1914

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251112000008 VA Practitioner - Physician Assistant 6204327802 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Eastern Virginia Medical School, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tidewater Emergency Medical Care, LTD..Group PAC ID 4183538150, 18 clinicians

Practice addresses (Care Compare)

736 Battlefield N Blvd
Chesapeake, VA 23320-4941
Phone (757) 312-6200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0110011308VAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Tidewater Emergency Medical Care, LTD. CurrentSince Nov 1, 2025 Accepting new patients
Chesapeake Observation Medicine Specialists, P.C. CurrentSince Feb 1, 2026 Accepting new patients
Tidewater Emergency Medical Care Physician Assistant PastSince Feb 2, 2020 Accepting new patients

Locations

736 Battlefield Blvd N
Chesapeake, VA 23320
Phone (757) 312-6124

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1736294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756944000000",
    "number": "1740090273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 FAIRFAX AVE",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 FAIRFAX AVE",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071914",
            "telephone_number": "757-446-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNINGTON-WINSLOW",
        "first_name": "MAKENZIE",
        "middle_name": "SLONE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-01-08",
        "last_updated": "2025-09-04",
        "certification_date": "2025-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110011308",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norfolk, VA

Sources for this page

Verify at the official NPI Registry.