Individual provider Active NPI

Ronnie Fayad, DO

  • Family Medicine Physician
  • Virginia Beach, VA
National Provider Identifier
1881335503
Registry record updated Jun 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0102209258 Issued in VA
Practice address
1147 Independence Blvd Ste a
Virginia Beach, VA 23455-5545
Phone
(757) 301-7729
NPI assigned
Apr 5, 2022
Last updated
Jun 23, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 0102209258 VA Primary

Addresses

Primary practice location

1147 Independence Blvd Ste a
Virginia Beach, VA 23455-5545

Mailing address

1147 Independence Blvd Ste a
Virginia Beach, VA 23455-5545
Phone (757) 301-7729

Other practice location 1

3640 High St Ste 3B
Portsmouth, VA 23707-3213
Phone (757) 397-6344

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250602001426 VA Practitioner - Family Practice 5294244273 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Edward Via Col of Osteo Medicine-Virginia Campus, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

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

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

Practice roles

OrganizationSpecialtyStatusNew patients
Tidewater Physicians Multispecialty Group PC CurrentSince May 27, 2025 Accepting new patients
Tidewater Physicians Multispecialty Group PC Family Medicine CurrentSince May 27, 2025 Accepting new patients

Locations

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

729 Thimble Shoals Blvd
Newport News, VA 23606
Phone (757) 874-1077

827 Diligence Dr
Ste 100
Newport News, VA 23606

860 Omni Blvd
Newport News, VA 23606
Phone (757) 369-8138

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

860 Omni Blvd
Ste 128
Newport News, VA 23606

1147 Independence Blvd
Ste A
Virginia Beach, VA 23455
Phone (757) 301-7729

Interoperability endpoints

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

Organizations & group practices 2

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 5

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": "1649116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750636800000",
    "number": "1881335503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1147 INDEPENDENCE BLVD STE A",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234555545",
            "telephone_number": "757-301-7729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1147 INDEPENDENCE BLVD STE A",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234555545",
            "telephone_number": "757-301-7729"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3640 High St Ste 3B",
            "address_purpose": "LOCATION",
            "city": "Portsmouth",
            "state": "VA",
            "postal_code": "237073213",
            "country_code": "US",
            "telephone_number": "757-397-6344",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAYAD",
        "first_name": "RONNIE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-05",
        "last_updated": "2025-06-23",
        "certification_date": "2025-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0102209258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

Verify at the official NPI Registry.