TIDEWATER REHABILITATION MEDICINE (NPI# 1891113155) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891113155 |
| Entity Type | Organization |
| Organization Name | TIDEWATER REHABILITATION MEDICINE |
| Practice Address |
1120 First Colonial Rd Suite 206 Virginia Beach VA 23454-2418 |
| Practice Telephone | 7574962325 |
| Practice Fax Number | 7574961942 |
| Mailing Telephone | 7574962325 |
| Mailing Fax Number | 7574961942 |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2015-04-25 |
| Authorized Official Name | MR. STEPHEN WALTER KAYOTA (SOLE OWNER/AUTHORIZE OFFICIAL) |
| Authorized Official Telephone | 7574962325 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208100000X | Physical Medicine & Rehabilitation | 0101053621 | VA | Allopathic & Osteopathic Physicians |
| Y | 2081P2900X |
Physical Medicine & Rehabilitation Specialization: Pain Medicine |
0101053621 | VA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | 1891113155 | 05 | |
| VA | DEPARTMENT OF LABOR | 618120600 | 01 |
| VA | AETNA | 1891113155 | 01 |
| VA | HUMANA MEDICARE | 1891113155 | 01 |
| VA | COVENTRY | 1891113155 | 01 |
| VA | ANTHEM BCBS VA | 1891113155 | 01 |
| VA | CIGNA | 1891113155 | 01 |
| VA | UNITED HEALTHCARE | 1891113155 | 01 |
| VA | VIRGINIA HEALTH NETWORK | 1891113155 | 01 |
| VA | OPTIMA | 1891113155 | 01 |
| VA | TRICARE | 1891113155 | 01 |
| Street Address |
1120 FIRST COLONIAL RD SUITE 206 |
| City | VIRGINIA BEACH |
| State | VA |
| Zip Code | 23454-2418 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891779468 | Jennifer Butler Reynaldo | Physician Assistant | 1120 First Colonial Rd, Suite 100, Virginia Beach, VA 23454-2418 | 2005-12-06 |
| 1114426038 | Erin Comerford | Internal Medicine | 1120 First Colonial Rd, Virginia Beach, VA 23454-2418 | 2018-02-06 |
| 1740703925 | Samantha Valdez | Physical Therapist | 1120 First Colonial Rd, Virginia Beach, VA 23454-2418 | 2017-07-19 |
| 1295135796 | Carolyn C Hatch | Physician Assistant | 1120 First Colonial Rd, Suite 100, Virginia Beach, VA 23454-2418 | 2014-09-03 |
| 1568717130 | Tyler Volpe | Physician Assistant | 1120 First Colonial Rd, Suite 100, Virginia Beach, VA 23454-2418 | 2012-07-19 |
| 1326378746 | Katharine K Malbon | Physician Assistant | 1120 First Colonial Rd, Suite 100, Virginia Beach, VA 23454-2418 | 2010-01-07 |
| 1083942742 | John Mapp | Family Medicine | 1120 First Colonial Rd, Suite 100, Virginia Beach, VA 23454-2418 | 2009-11-18 |
| 1942457874 | Jennifer C Kalb | Physician Assistant | 1120 First Colonial Rd, Suite 100, Virginia Beach, VA 23454-2418 | 2008-08-21 |
| 1174798151 | Cecelia D Rountree | Physician Assistant | 1120 First Colonial Rd, Suite 100, Virginia Beach, VA 23454-2418 | 2008-04-29 |
| 1578733523 | Melissa Tignor Shearer | Nurse Practitioner | 1120 First Colonial Rd, Suite 100, Virginia Beach, VA 23454-2418 | 2008-03-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356994263 | Agape Consulting | Behavioral Analyst | 1216 Garth Court, Virginia Beach, VA 23454 | 2019-07-19 |
| 1831650266 | Amelia Jo Crutsinger | Physician Assistant | 1644 Kepler Bnd, Virginia Beach, VA 23454 | 2019-03-28 |
| 1538639158 | Bay Psychiatric II Inc | Counselor | 923 First Colonial Rd Suite 1821, Virginia Beach, VA 23454 | 2018-11-26 |
| 1487151759 | Akanksha Mohan | Student in an Organized Health Care Education/Training Program | 100 Mannng Drive, Chapel Hill, Nc 27514, Chapel Hill, NC 23454 | 2018-04-12 |
| 1275038580 | Food Lion, LLC | Durable Medical Equipment & Medical Supplies | 1615 General Booth Blvd, Virginia Beach, VA 23454 | 2018-03-28 |
| 1346783164 | Tracy Chasse | Occupational Therapy Assistant | 1628 Old Donation Parkway, Virginia Beach, VA 23454 | 2016-11-28 |
| 1982066627 | Jennifer Mitchell | Speech-Language Pathologist | 2101 Agecroft Rd., Virginia Beach, VA 23454 | 2016-03-22 |
| 1659730562 | Rebecca Houvener | Psychologist | 1120 First Colonial Rd Ste 202, Virginia Beach, VA 23454 | 2016-02-19 |
| 1932581741 | Monica Jane Bailey | Nurse Practitioner | 2110 N Great Neck Rd, Virginia Beach, VA 23454 | 2015-06-29 |
| 1376930073 | Ashley A Burkholder | Family Medicine | 1024 First Colonial Rd Ste 104, Virginia Beach, VA 23454 | 2015-04-20 |
| Find all providers in zip 23454 | ||||
| Taxonomy Code | 2081P2900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Physical Medicine & Rehabilitation |
| Specialization | Pain Medicine |
| A physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source changed] Additional Resources: American Board of Physical Medicine and Rehabilitation, 2007. http://www.abpmr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Physical Medicine and Rehabilitation. A subspecialty certificate was approved by the ABMS in 1999. ACGME Accredited Residency Program Requirements: Proposal under development. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346279833 | Bonnie Jean Nock | Physical Medicine & Rehabilitation | 329 Edwin Dr Ste 101, Virginia Beach, VA 23462-4545 | 2006-06-30 |
| 1487682985 | Lisa B Barr | Physical Medicine & Rehabilitation | 933 First Colonial Rd Ste 200, Virginia Beach, VA 23454 | 2006-06-30 |
| 1073541736 | Steven Lloyd Gershon | Physical Medicine & Rehabilitation | 1133 First Colonial Rd., Virginia Beach, VA 23454-2402 | 2006-06-29 |
| 1124027305 | Daren Murray Wingard | Physical Medicine & Rehabilitation | 1060 First Colonial, Virginia Beach, VA 23454 | 2005-07-19 |
| 1437555083 | Walko Enterprise Incorporated | Physical Medicine & Rehabilitation | 1788 Republic Rd, Virginia Beach, VA 23454 | 2014-11-10 |
| 1801236286 | Comprehensive Spine & Pain Management | Physical Medicine & Rehabilitation | 816 Independence Blvd, Suite #2c, Virginia Beach, VA 23455-6010 | 2013-06-28 |
| 1871710798 | Gershon Pain Specialists, LLC | Physical Medicine & Rehabilitation | 1133 First Colonial Rd, Virginia Beach, VA 23454-2402 | 2007-04-20 |
| 1972532588 | David Scott Levi | Physical Medicine & Rehabilitation | 5716 Cleveland St Ste 200, Virginia Beach, VA 23462 | 2006-07-03 |
| 1497783153 | Robert Michael Spear | Physical Medicine & Rehabilitation | 1788 Republic Rd, Ste 200, Virginia Beach, VA 23454-4552 | 2006-06-29 |
| 1497791669 | Tracey O Pennington | Physical Medicine & Rehabilitation | 5320 Providence Rd, Suite 204, Virginia Beach, VA 23464-4122 | 2006-06-22 |
| Find all providers in VIRGINIA BEACH | ||||
| City | VIRGINIA BEACH |
| Zip Code | 23454 |
Please comment or provide details below to improve the information on TIDEWATER REHABILITATION MEDICINE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.