NPIMap

Individual provider Active NPI

Bleck B Ngwafang, MD

  • Family Medicine Physician
  • Midlothian, VA
National Provider Identifier
1962938803
Registry record updated Oct 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101267223 Issued in VA
Practice address
13540 Hull Street Rd
C/O Tonya Agosto
Midlothian, VA 23112-2107
Phone
(804) 739-6142
NPI assigned
May 11, 2017
Last updated
Oct 5, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 101267223 VA
Hospitalist Physician 208M00000X 0101267223 VA
Family Medicine Physician 207Q00000X 0101267223 VA Primary

Addresses

Primary practice location

13540 Hull Street Rd
C/O Tonya Agosto
Midlothian, VA 23112-2107

Mailing address

13540 Hull Street Rd
Midlothian, VA 23112-2107
Phone (804) 739-6142

Other practice location 1

2025 Glenn Mitchell Dr
Virginia Beach, VA 23456-0178
Phone (757) 507-4123

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210201002016 VA Practitioner - HospitalistPractitioner - Family Practice 4587078654 Reassigns benefits to 1 organization
I20231129000518 WI Practitioner - Family Practice 4587078654 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vituity-Virginia Hospitalists PCGroup PAC ID 6507245131, 109 clinicians

Practice addresses (Care Compare)

5801 Bremo Rd
Richmond, VA 23226-1907
Phone (804) 285-2011

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
101267223VAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Vituity-Virginia Hospitalists PC Hospitalist CurrentSince Jun 1, 2022 Accepting new patients
Apogee Medical Group, Wisconsin, S.C CurrentSince Nov 1, 2023 Accepting new patients

Locations

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 350-2663

13710 St Francis Blvd
Midlothian, VA 23114
Phone (804) 594-7300

5801 Bremo Rd
Richmond, VA 23226
Phone (804) 281-8220

2000 N Dewey Ave
Reedsburg, WI 53959
Phone (608) 524-6487

125 Hospital Dr
Watertown, WI 53098
Phone (920) 261-4210

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 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1494460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633392000000",
    "number": "1962938803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13540 HULL STREET RD",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "231122107",
            "telephone_number": "804-739-6142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13540 HULL STREET RD",
            "address_2": "C/O TONYA AGOSTO",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "231122107",
            "telephone_number": "804-739-6142"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2025 Glenn Mitchell Dr",
            "address_purpose": "LOCATION",
            "city": "Virginia Beach",
            "state": "VA",
            "postal_code": "234560178",
            "country_code": "US",
            "telephone_number": "757-507-4123",
            "fax_number": "757-716-3976",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NGWAFANG",
        "first_name": "BLECK",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-11",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "101267223",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "VA",
            "license": "0101267223",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101267223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Midlothian, VA

Sources for this page

Verify at the official NPI Registry.