NPIMap

Individual provider Active NPI

Mary Elizabeth Wade Diaz, DO

  • Family Medicine Physician
  • Virginia Beach, VA
National Provider Identifier
1750919130
Registry record updated Sep 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0102208179 Issued in VA
Practice address
828 Healthy Way Ste 220
Virginia Beach, VA 23462-7960
Phone
(757) 305-1797
Fax
(757) 309-4715
NPI assigned
Mar 31, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2023

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 0102208179 VA Primary

Addresses

Primary practice location

828 Healthy Way Ste 220
Virginia Beach, VA 23462-7960

Mailing address

828 Healthy Way Ste 220
Virginia Beach, VA 23462-7960
Phone (757) 305-1797

Other names 1

  • Mary Elizabeth Wade Former name

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
I20231108000793 VA Practitioner - Family Practice 0840647145 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Liberty Univ College of Osteopathic Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bon Secours Medical Group Hampton Roads Primary Care LLCGroup PAC ID 0941632756, 62 clinicians

Practice addresses (Care Compare)

3537 Airline Blvd
Suite 1
Portsmouth, VA 23701-2650
Phone (757) 738-1225

828 Healthy Way
Suite 220
Virginia Beach, VA 23462-7960
Phone (757) 305-1797

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0102208179VAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bon Secours Medical Group Hampton Roads Primary Care LLC CurrentSince Sep 5, 2023 Accepting new patients

Locations

3537 Airline Blvd
Ste 1
Portsmouth, VA 23701
Phone (757) 738-1225

828 Healthy Way
Ste 220
Virginia Beach, VA 23462
Phone (757) 305-1797

Organizations & group practices 1

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1585612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694563200000",
    "number": "1750919130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "828 HEALTHY WAY STE 220",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234627960",
            "telephone_number": "757-305-1797",
            "fax_number": "757-309-4715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "828 HEALTHY WAY STE 220",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234627960",
            "telephone_number": "757-305-1797",
            "fax_number": "757-309-4715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADE DIAZ",
        "first_name": "MARY",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-31",
        "last_updated": "2023-09-13",
        "certification_date": "2023-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0102208179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "WADE",
            "middle_name": "ELIZABETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Virginia Beach, VA

Sources for this page

Verify at the official NPI Registry.