Organization Active NPI

NSG Wellness LLC

  • Nurse Practitioner
  • Hampton, VA
National Provider Identifier
1780399386
Registry record updated Jan 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
NSG WELLNESS LLC
Practice address
210 Lowden Hunt Dr
Hampton, VA 23666-2248
Phone
(757) 712-4767
NPI assigned
Jan 18, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2023

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

Authorized official

Name
Noelle S Green, NPNPI 1649766569
Title
Owner
Phone
(757) 712-4767

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

210 Lowden Hunt Dr
Hampton, VA 23666-2248

Mailing address

110 Coliseum Xing # 5462
Hampton, VA 23666-5971
Phone (757) 712-4767

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL SHARENOTE Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241025000247 VA Part B Supplier - Clinic/Group Practice 9436682762 Receives reassigned benefits from 1 practitioner
Practice locations: Hampton, VA

National Provider Directory

National Provider Directory

Locations

1919 Commerce Dr
Ste 240
Hampton, VA 23666
Phone (757) 291-3339

Practitioners & affiliated clinicians

Practitioners 1

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": "1674000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674000000000",
    "number": "1780399386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 COLISEUM XING # 5462",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236665971",
            "telephone_number": "757-712-4767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 LOWDEN HUNT DR",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236662248",
            "telephone_number": "757-712-4767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NSG WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-18",
        "last_updated": "2023-01-18",
        "certification_date": "2023-01-12",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "NOELLE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "757-712-4767",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "SHARENOTE",
            "affiliation": "N",
            "endpointDescription": "OFFICE SERVER",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "PRACTICE SOFTWARE",
            "address_1": "110 Coliseum Xing # 5462",
            "city": "Hampton",
            "state": "VA",
            "country_code": "US",
            "postal_code": "236665971",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hampton, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 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.