Tidewater Rehabilitation Medicine

Primary specialty

Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X

License

0101053621 Issued in VA

Legal business name

TIDEWATER REHABILITATION MEDICINE

Practice address

1120 First Colonial Rd
Suite 206
Virginia Beach, VA 23454-2418

Phone

(757) 496-2325

Fax

(757) 496-1942

NPI assigned

Apr 3, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Stephen Walter Kayota, M.D.NPI 1083687099

Title

Sole Owner/Authorize Official

Phone

(757) 496-2325

Specialties & licenses 2

Addresses

Other identifiers 11

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 2

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

• Stephen W. Kayota, MD

  • Physical Medicine & Rehabilitation Physician
  • Virginia Beach, VA
  • NPI 1083687099
  Medicare reassignment Authorized official
• Gerry Nieman Smith, MD

  • Physical Medicine & Rehabilitation Physician
  • Virginia Beach, VA
  • NPI 1215991377
  NPD

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

{
    "created_epoch": "1396483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429920000000",
    "number": "1891113155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 FIRST COLONIAL RD",
            "address_2": "SUITE 206",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234542418",
            "telephone_number": "757-496-2325",
            "fax_number": "757-496-1942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 FIRST COLONIAL RD",
            "address_2": "SUITE 206",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234542418",
            "telephone_number": "757-496-2325",
            "fax_number": "757-496-1942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER REHABILITATION MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-03",
        "last_updated": "2015-04-25",
        "status": "A",
        "authorized_official_last_name": "KAYOTA",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "WALTER",
        "authorized_official_title_or_position": "SOLE OWNER/AUTHORIZE OFFICIAL",
        "authorized_official_telephone_number": "757-496-2325",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "VA",
            "license": "0101053621",
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "VA",
            "license": "0101053621",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "1891113155",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS VA",
            "identifier": "1891113155",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1891113155",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTIMA",
            "identifier": "1891113155",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COVENTRY",
            "identifier": "1891113155",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA MEDICARE",
            "identifier": "1891113155",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1891113155",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VIRGINIA HEALTH NETWORK",
            "identifier": "1891113155",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1891113155",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF LABOR",
            "identifier": "618120600",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "1891113155",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tidewater Physical Therapy, LLC
• Tidewater Physical Therapy, LLC
• Tidewater Podiatry Group
• Tidewater Psychotherapy Services
• Tidewater Psychotherapy Services
• Tidewater Skin Care and Pathology PC
• Mercedes A. Tierney, M.S. CCC/SLP, M.S.ED
• Tiffany Foster Kessler, DDS (A Division of Atlantic Dental Care)
• Meghann G Tignor, CCC-SLP
• Anna Tihomirova, M.S.

• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2015; 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.