DR. RICHARD M. WHALEN MD
NPI 1003881483
Family Medicine in Norfolk, VA

Active since February 21, 2006PECOS EnrolledAccepts Medicare Assignment
95.11/100
CMS Quality Rating
825 FAIRFAX AVE, SUITE 118, NORFOLK, VA 23507(757) 446-5955(757) 446-5196 Get Directions Write a Review

NPPES record last updated: October 3, 2011. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Dr. Richard M. Whalen Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. RICHARD M. WHALEN MD (NPI 1003881483) is an individual family medicine provider in Norfolk, Virginia, licensed in Virginia (0101039984) and active in the NPI registry since February 2006. He is enrolled in Medicare PECOS, is affiliated with Sentara Norfolk General Hospital, and is a graduate of Eastern Virginia Medical School (1985).

NPPES Registry Identity

NPI1003881483
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameDR. RICHARD M. WHALENCredential: MD
Location Address825 FAIRFAX AVE, SUITE 118Norfolk, VA 23507-1914
Mailing AddressPo Box 936Norfolk, VA 23501-0936 · (757) 446-5955 · Fax (757) 446-5196
Fax(757) 446-5196
Sole ProprietorNo
Medical School CMSEastern Virginia Medical SchoolGraduated 1985
Enumeration DateFebruary 21, 2006
Last NPPES UpdateOctober 3, 2011
NPI 1003881483 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License Licensed in VA · 0101039984
Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

825 FAIRFAX AVE, Norfolk, VA 23507

Other Identifiers 17

Other426444VA · Anthem Bc/bs
Other426447VA · Anthem Bc/bs
Other78535VA · Optima Health
OtherPARVA · United Healthcare/mamsi
OtherPARVA · First Health Commercial/coventry Health/southern Health
OtherPARVA · Usa Managed Care
OtherPARVA · Aetna
OtherPARVA · Virgina Premier Health Plan
Medicaid5917806NC
OtherPARVA · Multiplan
Other-002VA · Tricare/champus
OtherPARVA · Corvel
OtherPARVA · Cigna
Medicare UPINC47169
OtherPARVA · Virginia Health Network
Medicaid1003881483VA
Medicare PINVV2368AVA

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Dr. Richard M. Whalen Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8729052428
PECOS Enrollment IDI20040819001057
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 7

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
67 services58 patients
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232
Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.
57 services15 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
22 services19 patients
Hemoglobin a1c level 83036
Hemoglobin A1c (HbA1c) is a test that measures your average blood sugar level over the past 2-3 months. It's used to monitor how well diabetes is being controlled. High levels may indicate that your diabetes treatment plan needs adjustment.
18 services14 patients
Hospital discharge day management, more than 30 minutes 99239
Hospital discharge day management over 30 minutes involves a detailed process to ensure a smooth transition from hospital to home. It includes final examinations, discussion of your hospital stay, post-discharge instructions, and coordinating follow-up care.
12 services12 patients
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439
An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
12 services12 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Sentara Norfolk General Hospital

Acute Care Hospitals · Norfolk, VA
3/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number490007
Location600 Gresham DrNorfolk, VA 23507 · Norfolk City County
Emergency services Birthing friendly

Sentara Leigh Hospital

Acute Care Hospitals · Norfolk, VA
4/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number490046
Location830 Kempsville RoadNorfolk, VA 23502 · Norfolk City County
Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 23507 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$86.88 typical visit price
range $56.19 – $170.30
Typical copayment $21.72 (range $14.04 – $42.57)
Most-billed visit code 99203
Established Patient
$99.13 typical visit price
range $18.07 – $138.91
Typical copayment $24.78 (range $4.51 – $34.72)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

95.11/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality86.31
Promoting Interoperability100
Improvement Activities40

Referred Medical Equipment & Supplies CMS DME claims 2

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress E0260
DME-Hospital Beds · category DB000N
1 supplier12 claims12 services$31.18 avg. paid by Medicare
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390
DME-Oxygen and Supplies · category DC002N
1 supplier11 claims11 services$62.25 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Internal Medicine (Nephrology)
825 FAIRFAX AVE
NORFOLK, VA 23507
Student in an Organized Health Care Education/Training Program
825 FAIRFAX AVE
NORFOLK, VA 23507
Student in an Organized Health Care Education/Training Program
825 FAIRFAX AVE
NORFOLK, VA 23507
Nurse Practitioner (Family)
825 FAIRFAX AVE, 118
NORFOLK, VA 23507
Student in an Organized Health Care Education/Training Program
825 FAIRFAX AVE
NORFOLK, VA 23507
Student in an Organized Health Care Education/Training Program
825 FAIRFAX AVE
NORFOLK, VA 23507
Student in an Organized Health Care Education/Training Program
825 FAIRFAX AVE
NORFOLK, VA 23507
Psychiatry & Neurology (Psychiatry)
825 FAIRFAX AVE, SUITE 710
NORFOLK, VA 23507

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Richard Whalen's NPI number?

The NPI number for Richard Whalen is 1003881483. It was assigned to this individual provider in the NPPES registry on February 21, 2006.

Where is Richard Whalen located?

Richard Whalen practices at 825 Fairfax Ave Suite 118, Norfolk, VA 23507. The listed phone number is (757) 446-5955.

What is Richard Whalen's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Richard Whalen enrolled in Medicare?

Yes. Richard Whalen is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Is Richard Whalen affiliated with any hospitals?

According to CMS data, Richard Whalen is affiliated with Sentara Norfolk General Hospital and Sentara Leigh Hospital.

When was this NPI record last updated?

The NPPES record for Richard Whalen was last updated on October 3, 2011. NPI Profile syncs with the weekly NPPES data releases published by CMS.