Individual provider Active NPI

Jordan S Snider, PA-C

  • Physician Assistant
  • Newport News, VA
National Provider Identifier
1861012064
Registry record updated Dec 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110007336 Issued in VA
Practice address
860 Omni Blvd Ste 114
Newport News, VA 23606-4430
Phone
(757) 232-8856
Fax
(757) 232-8857
NPI assigned
Apr 17, 2020
Last updated
Dec 18, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 18, 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 0110007336 VA Primary

Addresses

Primary practice location

860 Omni Blvd Ste 114
Newport News, VA 23606-4430

Mailing address

860 Omni Blvd Ste 401
Newport News, VA 23606-4430
Phone (757) 232-8860

Other practice location 1

6379 Center Dr
Norfolk, VA 23502-4102
Phone (757) 467-4200

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
I20200826002943 VA Practitioner - Physician Assistant 6305263039 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Eastern Virginia Medical School, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

860 Omni Blvd
Suite 114
Newport News, VA 23606-4430
Phone (757) 806-6092

Merit-based Incentive Payment System (MIPS)

Final score
97.87 of 100Reported as group
Quality
95.04
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0110007336VAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Tidewater Physicians Multispecialty Group PC CurrentSince Jan 1, 2026 Accepting new patients
Tidewater Physicians Multispecialty Group PC Multi-Specialty CurrentSince Jan 1, 2026 Accepting new patients

Locations

704 Thimble Shoals Blvd
#30
Newport News, VA 23606
Phone (757) 595-4300

827 Diligence Dr
Ste 100
Newport News, VA 23606

860 Omni Blvd
Ste 114
Newport News, VA 23606
Phone (757) 232-8856

860 Omni Blvd
Ste 401
Newport News, VA 23606
Phone (757) 232-8764

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BGFHDD

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": "1587081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766016000000",
    "number": "1861012064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "860 OMNI BLVD STE 401",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236064430",
            "telephone_number": "757-232-8860",
            "fax_number": "757-232-8875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "860 OMNI BLVD STE 114",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236064430",
            "telephone_number": "757-232-8856",
            "fax_number": "757-232-8857"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6379 Center Dr",
            "address_purpose": "LOCATION",
            "city": "Norfolk",
            "state": "VA",
            "postal_code": "235024102",
            "country_code": "US",
            "telephone_number": "757-467-4200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SNIDER",
        "first_name": "JORDAN",
        "middle_name": "S",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-17",
        "last_updated": "2025-12-18",
        "certification_date": "2025-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110007336",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newport News, VA

Sources for this page

Verify at the official NPI Registry.