TIDEWATER PHYSICIANS MULTISPECIALTY GROUP PC – Family Medicine Physician, NPI 1902848294
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for TIDEWATER PHYSICIANS MULTISPECIALTY GROUP PC
Omni Boulevard, City Center, Newport News, Newport News City, Virginia, 23606, United States
NEWPORT NEWS, VA 236064430
Phone: (757) 232-8769
Fax: (757) 232-8875
Type: Mailing
860, Omni Boulevard, City Center, Newport News, Newport News City, Virginia, 23606, United States
SUITE 303
NEWPORT NEWS, VA 236064430
Phone: (757) 232-8764
Fax: (757) 232-8875
Type: Location
860 OMNI BLVD STE 128
NEWPORT NEWS, VA 236064483
Phone: (757) 232-8769
Fax: (757) 232-8875
Type: Mailing
11761 ROCK LANDING DR STE 8
NEWPORT NEWS, VA 236064235
Phone: (757) 232-8769
Fax: (757) 232-8875
Type: Mailing
860 OMNI BLVD STE 401
NEWPORT NEWS, VA 236064430
Phone: (757) 232-8764
Type: Location
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: 2010-05-24
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
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 |
|---|---|---|---|---|
| O20031211000980 | O | Clinic/Group Practice | VA | TBD |
| O20100524000041 | O | Independent Clinical Laboratory | VA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
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 23606)
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