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AUTHENTIC SELF COUNSELING SERVICES
NPI 1225527351
Family Medicine in Portsmouth, VA

Active since May 03, 2018
3520 HIGH ST STE 100, PORTSMOUTH, VA 23707(757) 977-9675(757) 483-8099 Get Directions Write a Review

NPPES record last updated: January 21, 2022. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Jan 21, 2022, May 9, 2019, Apr 17, 2019 and 1 more (4 updates tracked since 2018).

About Authentic Self Counseling Services NPPES

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

AUTHENTIC SELF COUNSELING SERVICES (NPI 1225527351) is a healthcare organization registered as a family medicine in Portsmouth, Virginia and active in the NPI registry since May 2018. The organization maintains a secondary practice location in Chesapeake and lists Jimmy Cooper, Ceo/owner, as its authorized official.

NPPES Registry Identity

NPI1225527351
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameTIDEWATER MOBILE MEDICINE, PLLC
Location Address3520 HIGH ST STE 100Portsmouth, VA 23707-3126
Mailing Address3520 High St Ste 100Portsmouth, VA 23707-3126 · (757) 977-9675 · Fax (757) 483-4099
Phone(757) 977-9675
Fax(757) 483-8099
Organization SubpartYesParent: Tidewater Mobile Medicine Pllc
Authorized OfficialJimmy CooperCeo/owner · (757) 977-9675
Enumeration DateMay 3, 2018
Last NPPES UpdateJanuary 21, 20224 updates tracked since enumeration
NPPES CertifiedJanuary 21, 2022
✔ NPI 1225527351 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 5

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
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.
Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X
Also ListedSocial Worker · ClinicalTaxonomy 1041C0700X
Also ListedClinic/Center · Primary CareTaxonomy 261QP2300X · License 46193 (VA)
Also ListedNon-emergency Medical Transport (VAN)Taxonomy 343900000X
3520 HIGH ST STE 100, Portsmouth, VA 23707
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Other Names 2

Doing Business AsAuthentic Self Counseling Services
Doing Business AsTmm Medical Group

Secondary Practice Location 1

Location 13001 Churchland BlvdChesapeake, VA 23321-5603 · Phone (757) 977-9675 · Fax (757) 483-8099

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Authentic Self Counseling Services is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

4

Medicare enrollment records show 4 clinicians reassign Medicare billing to Authentic Self Counseling Services, which bills Medicare for the services they deliver. Of these, 3 practice at this address. They are listed nearest first.

Clinicians, nearest first (4)

Jimmy Cooper, DHA, FNP-C
Nurse Practitioner
NPI 1205123171
3520 HIGH ST STE 100
Portsmouth, VA 23707
(757) 338-4012
✔ PECOS✔ Accepts MedicareSame address
Maisie Cowden, APRN
Nurse Practitioner
NPI 1164376752
3520 HIGH ST
Portsmouth, VA 23707
(757) 977-9675
✔ PECOS✔ Accepts MedicareSame address
Shauna Thomas, FNP-BC
Nurse Practitioner
NPI 1447721881
3520 HIGH ST STE 100
Portsmouth, VA 23707
(757) 977-9675
✔ PECOS✔ Accepts MedicareSame address
Precious Gillispie, FNP-BC
Nurse Practitioner
NPI 1568261840
1101 OLD BUCKROE RD
Hampton, VA 23663
(757) 602-6893
✔ PECOS✔ Accepts Medicare14 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Tidewater Mobile Medicine, PLLC's NPI number?

The NPI number for Tidewater Mobile Medicine, PLLC is 1225527351. It was assigned to this organization in the NPPES registry on May 3, 2018. The provider is doing business as Authentic Self Counseling Services and TMM Medical Group.

Where is Tidewater Mobile Medicine, PLLC located?

Tidewater Mobile Medicine, PLLC is located at 3520 High St Ste 100, Portsmouth, VA 23707. The listed phone number is (757) 977-9675.

What is Tidewater Mobile Medicine, PLLC's specialty?

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

Is Tidewater Mobile Medicine, PLLC enrolled in Medicare?

Yes. Tidewater Mobile Medicine, PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Tidewater Mobile Medicine, PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Tidewater Mobile Medicine, PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 3 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Tidewater Mobile Medicine, PLLC was last updated on January 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.