NPIMap

Organization Active NPI

Procare Wellness Network Inc

  • Physical Medicine & Rehabilitation Physician
  • Virginia Beach, VA
National Provider Identifier
1760174825
Registry record updated May 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
PROCARE WELLNESS NETWORK INC
Practice address
293 Independence Blvd
Pembroke 5, Suite 330
Virginia Beach, VA 23462
Phone
(757) 222-3100
NPI assigned
May 25, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 25, 2023

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

Authorized official

Name
Domenick Pisciotta
Title
Authorized Official
Phone
(516) 315-4732

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X Primary

Addresses

Primary practice location

293 Independence Blvd
Pembroke 5, Suite 330
Virginia Beach, VA 23462

Mailing address

293 Independence Blvd
Pembroke 5, Suite 330
Virginia Beach, VA 23462

Other names 1

  • PROCARE WELLNESS INSTITUTE OF VIRGINIA BEACH Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20230711000274 VA Part B Supplier - Clinic/Group Practice 5294194171 Receives reassigned benefits from 13 practitioners
Practice locations: Virginia Beach, VA
O20250127000256 VA DME Supplier - Multi-Specialty - PhysicianDME Supplier - Nurse Practitioner 5294194171 Practice locations: Virginia Beach, VA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Procare Wellness Network Inc293 Independence Blvd, Virginia Beach, VA 23462-5466(757) 222-3100 Contracture Treatment Devices: Dynamic Splint|Canes and/or Crutches|Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Surgical Dressings Accepts assignmentParticipating since Jun 27, 2023

National Provider Directory

National Provider Directory

Locations

293 Independence Blvd
Ste 330
Virginia Beach, VA 23462
Phone (757) 222-3100

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1684972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684972800000",
    "number": "1760174825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "293 INDEPENDENCE BLVD",
            "address_2": "PEMBROKE 5, SUITE 330",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "23462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "293 INDEPENDENCE BLVD",
            "address_2": "PEMBROKE 5, SUITE 330",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "23462",
            "telephone_number": "757-222-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROCARE WELLNESS NETWORK INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-25",
        "last_updated": "2023-05-25",
        "certification_date": "2023-05-16",
        "status": "A",
        "authorized_official_last_name": "PISCIOTTA",
        "authorized_official_first_name": "DOMENICK",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "516-315-4732"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROCARE WELLNESS INSTITUTE OF VIRGINIA BEACH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Virginia Beach, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.