NPIMap

Individual provider Active NPI

Lisa Colette Jenkins-Haynie, MD

  • Family Medicine Physician
  • White Stone, VA
National Provider Identifier
1811975162
Registry record updated May 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101057965 Issued in VA
Practice address
30 Shady LN
White Stone, VA 22578-2601
Phone
(804) 453-3133
Fax
(804) 453-1311
NPI assigned
Jan 6, 2006
Last updated
May 23, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2019

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 0101057965 VA Primary

Addresses

Primary practice location

30 Shady LN
White Stone, VA 22578-2601

Mailing address

856 J Clyde Morris Blvd
Suite a
Newport News, VA 23601-1318

Other practice location 1

17452 Richmond Road
Callao, VA 22435
Phone (804) 529-6141

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
I20080522000245 VA Practitioner - Family Practice 1658440243 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Morehouse School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Riverside Physician Services IncGroup PAC ID 5092608448, 793 clinicians

Practice addresses (Care Compare)

30 Shady LN
White Stone, VA 22578-2601
Phone (804) 435-3133

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.91 of 100Reported as apm
Quality
92.86
Promoting interoperability
94.93
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101057965VAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Riverside Physician Services Inc CurrentSince Jun 10, 2013 Accepting new patients
Riverside Physician Services Inc Current Accepting new patients
Riverside Physician Services, Inc. Family Medicine CurrentSince Jun 10, 2013 Accepting new patients
Riverside Physician Services Inc Family Medicine Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

856 J Clyde Morris Blvd
Ste A
Newport News, VA 23601
Phone (757) 316-5900

858 J Clyde Morris Blvd
Newport News, VA 23601
Phone (757) 594-4343

Interoperability endpoints

  • Direct secure messaging: ljenkinshaynie12299@direct.rivhs.com

Organizations & group practices 5

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1136505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558569600000",
    "number": "1811975162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "856 J CLYDE MORRIS BLVD",
            "address_2": "SUITE A",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236011318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 SHADY LN",
            "city": "WHITE STONE",
            "state": "VA",
            "postal_code": "225782601",
            "telephone_number": "804-453-3133",
            "fax_number": "804-453-1311"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17452 Richmond Road",
            "address_purpose": "LOCATION",
            "city": "Callao",
            "state": "VA",
            "postal_code": "22435",
            "country_code": "US",
            "telephone_number": "804-529-6141",
            "fax_number": "804-529-6916",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JENKINS-HAYNIE",
        "first_name": "LISA",
        "middle_name": "COLETTE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-06",
        "last_updated": "2019-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101057965",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in White Stone, VA

Sources for this page

Verify at the official NPI Registry.