TIDEWATER REHABILITATION MEDICINE
NPI 1891113155
Physical Medicine & Rehabilitation - Pain Medicine in Virginia Beach, VA
NPI Status: Active since April 03, 2014
Contact Information
1120 FIRST COLONIAL RD
SUITE 206
VIRGINIA BEACH, VA
ZIP 23454
Phone: (757) 496-2325
Fax: (757) 496-1942
- Organization
- Physical Medicine & Rehabilitation
- Pain Medicine
- CLIA Number: 49D2059732
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 05-28-2027
About TIDEWATER REHABILITATION MEDICINE
This page provides the complete NPI Profile along with additional information for Tidewater Rehabilitation Medicine, a provider established in Virginia Beach, Virginia operating as a Physical Medicine & Rehabilitation, focusing in pain medicine . The healthcare provider is registered in the NPI registry with number 1891113155 assigned on April 2014. The practitioner's primary taxonomy code is 2081P2900X with license number 0101053621 (VA). The provider is registered as an organization and their NPI record was last updated 11 years ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The authorized official of this NPI record is Mr. Stephen Walter Kayota M.d. (Sole Owner/authorize Official)
- NPI
- 1891113155
- Provider Name
- TIDEWATER REHABILITATION MEDICINE
- Entity Type
- Organization
- Location Address
- 1120 FIRST COLONIAL RD SUITE 206 VIRGINIA BEACH, VA 23454
- Location Phone
- (757) 496-2325
- Location Fax
- (757) 496-1942
- Mailing Address
- 1120 FIRST COLONIAL RD SUITE 206 VIRGINIA BEACH, VA 23454
- Mailing Phone
- (757) 496-2325
- Mailing Fax
- (757) 496-1942
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 04-03-2014
- Last Update Date
- 04-25-2015
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Physical Medicine & Rehabilitation Pain Medicine
- Taxonomy Code
- 2081P2900X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 0101053621
- License State
- VA
- Taxonomy Description
- 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.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 0101053621 (VA) |
Group Taxonomy 193400000X MULTIPLE SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 1891113155 | OTHER (01) | VA | UNITED HEALTHCARE |
| 1891113155 | OTHER (01) | VA | AETNA |
| 1891113155 | OTHER (01) | VA | ANTHEM BCBS VA |
| 618120600 | OTHER (01) | VA | DEPARTMENT OF LABOR |
| 1891113155 | OTHER (01) | VA | CIGNA |
| 1891113155 | OTHER (01) | VA | VIRGINIA HEALTH NETWORK |
| 1891113155 | OTHER (01) | VA | HUMANA MEDICARE |
| 1891113155 | OTHER (01) | VA | COVENTRY |
| D620 | MEDICARE PIN (08) | VA | |
| 1891113155 | OTHER (01) | VA | OPTIMA |
| 1891113155 | OTHER (01) | VA | TRICARE |
| 1891113155 | MEDICAID (05) | VA |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 49D2059732
- Facility Type
- Physician Office
- Certificate Effective Date
- May 29, 2025
- Certificate Expiration Date
- May 28, 2027
- Laboratory Director
- WAYNE R. DEVANTIER
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Tidewater Rehabilitation Medicine to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
Reviews for TIDEWATER REHABILITATION MEDICINE
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1891113155, we treat the final digit (5) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 55. The final step is to find the difference between that total and the next multiple of ten (60 - 55 = 5).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 55 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 20 providers are registered at the same or a nearby location.
VIRGINIA BEACH, VA 23454
VIRGINIA BEACH, VA 23454
VIRGINIA BEACH, VA 23454
VIRGINIA BEACH, VA 23454
VIRGINIA BEACH, VA 23454
VIRGINIA BEACH, VA 23454
VIRGINIA BEACH, VA 23454
VIRGINIA BEACH, VA 23454
VIRGINIA BEACH, VA 23454
VIRGINIA BEACH, VA 23454
VIRGINIA BEACH, VA 23454
VIRGINIA BEACH, VA 23454
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1891113155, enumerated as an "organization" on April 03, 2014.
The provider is located at 1120 FIRST COLONIAL RD SUITE 206 VIRGINIA BEACH, VA 23454 and the phone number is (757) 496-2325.
Physical Medicine & Rehabilitation with taxonomy code 2081P2900X and a focus in Pain Medicine.
The provider might be accepting Accepts: Medicare, Medicaid, Aetna, Blue Cross Blue Shield,. Please consult your insurance carrier or call the provider to verify.
