TIDEWATER ORTHOPAEDIC ASSOCIATES INC – Orthopaedic Surgery Physician, NPI 1225058548
Orthopaedic Surgery Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for TIDEWATER ORTHOPAEDIC ASSOCIATES INC
4037 Ironbound Rd
Williamsburg, VA 231882507
Phone: (757) 206-1004
Fax: (757) 645-3965
Type: Location
3920A Bridge Rd Ste 305
Suffolk, VA 234351126
Phone: (757) 251-2971
Type: Location
7007 Harbour View Blvd Ste 108
Suffolk, VA 234353657
Phone: (757) 827-2480
Fax: (757) 827-2566
Type: Location
901 ENTERPRISE PKWY STE 900
HAMPTON, VA 236666250
Phone: (757) 827-2480
Fax: (757) 827-2566
Type: Location
901, Enterprise Parkway, Hampton Roads Center - South Campus, Hampton City, Virginia, 23666, United States
SUITE 900
HAMPTON, VA 23666
Phone: (757) 827-2480
Fax: (757) 282-5848
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2011-10-12
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Revalidation due soon
Earliest CMS due date is 2026-06-30 (18 days away).
Enrollment records
2
Earliest due date
2026-06-30
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20040207000398 | O | Clinic/Group Practice | VA | 2026-10-31 |
| O20111012000681 | O | Multi-Specialty - Physician | VA | 2026-06-30 |
What to do next
- Confirm the due date on the CMS Revalidation Lookup Tool.
- Complete revalidation in PECOS before the published due date.
- If you have multiple enrollment records, revalidate each one on its own schedule.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 23188)
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