Martha Anne Versprille, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

0110001949 Issued in VA

Practice address

301 Riverview Ave Ste 512
Norfolk, VA 23510-1066

Phone

(757) 623-0005

Fax

(757) 389-5774

NPI assigned

May 3, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VA, NC2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tidewater Kidney Specialists, Inc.

  • Nephrology Physician
  • Virginia Beach, VA
  • NPI 1780624627

  NC

  Medicare reassignment NPD

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642636800000",
    "number": "1952369100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4445 CORPORATION LN STE 100",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234623666",
            "telephone_number": "757-623-0005",
            "fax_number": "757-548-1129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 RIVERVIEW AVE STE 512",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235101066",
            "telephone_number": "757-623-0005",
            "fax_number": "757-389-5774"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 Medical Pkwy",
            "address_2": "Suite 110",
            "address_purpose": "LOCATION",
            "city": "Chesapeake",
            "state": "VA",
            "postal_code": "233204985",
            "country_code": "US",
            "telephone_number": "757-623-0005",
            "fax_number": "757-410-7349",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VERSPRILLE",
        "first_name": "MARTHA",
        "middle_name": "ANNE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-03",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110001949",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "001000355",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010250862",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jennifer Z Vevoda, OTR/L
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• Kristin Vickers, PA-C

• Medical Physician Assistant in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Medical Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.