ISC PORTSMOUTH HEALTH SERVICES DIVISION USCG (NPI# 1417007790) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417007790 |
| Entity Type | Organization |
| Organization Name | ISC PORTSMOUTH HEALTH SERVICES DIVISION USCG |
| Other Organization Name | ISC PORTSMOUTH CLINIC |
| Practice Address |
4000 Coast Guard Blvd Portsmouth VA 23703-2199 |
| Practice Telephone | 7574838597 |
| Practice Fax Number | 7574838610 |
| Mailing Telephone | 7574838597 |
| Mailing Fax Number | 7574838610 |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. MICHAEL J CRISTY (CHIEF, HEALTH SERVICES DIVISION) |
| Authorized Official Telephone | 7574838686 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1100X |
Clinic/Center Specialization: Military/U.S. Coast Guard Outpatient |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| ISC Portsmouth Clinic | Other Name - Individual/Organization |
| Street Address |
4000 COAST GUARD BLVD |
| City | PORTSMOUTH |
| State | VA |
| Zip Code | 23703-2199 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902882434 | Renard Garcia Scott | Military Health Care Provider | 4000 Coast Guard Blvd, Medical Division, Portsmouth, VA 23703-2135 | 2005-12-16 |
| 1659848729 | Cathy Elaine Guyer | Dental Hygienist | 4000 Coast Guard Blvd, Portsmouth, VA 23703-2135 | 2018-10-26 |
| 1437522406 | Lisa Rivera | Dental Hygienist | 4000 Coast Guard Blvd, Portsmouth, VA 23703-2135 | 2015-11-12 |
| 1194192781 | Megan Zieger | Social Worker | 4000 Coast Guard Blvd, Portsmouth, VA 23703-2135 | 2015-08-31 |
| 1083024665 | Stewart Wesley Calloway | Technician, Other | 4000 Coast Guard Blvd, Portsmouth, VA 23703-2135 | 2014-05-05 |
| 1437569209 | Cindy Holbeck | Technician, Other | 4000 Coast Guard Blvd, Portsmouth, VA 23703-2135 | 2014-05-02 |
| 1902226236 | Heather Johnson | Military Health Care Provider | 4000 Coast Guard Blvd, Portsmouth, VA 23703 | 2014-04-25 |
| 1619397023 | Eric Luongo | Technician, Health Information | 4000 Coast Guard Blvd, Portsmouth, VA 23703-2135 | 2014-04-24 |
| 1316367766 | Amanda Kitson | Technician, Other | 4000 Coast Guard Blvd, Portsmouth, VA 23703-2135 | 2014-04-24 |
| 1790105187 | Paul Stuart V | Military Health Care Provider | 4000 Coast Guard Blvd, Portsmouth, VA 23703-2135 | 2014-04-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174037444 | Kelly Foster | Massage Therapist | 3108 Tyre Neck Rd Ste D, Portsmouth, VA 23703 | 2017-11-25 |
| 1578072104 | Katherine Armstrong Wise | Behavior Technician | 3120 Verne Ave, Portsmouth, VA 23703 | 2017-09-27 |
| 1891223913 | Ashley Rebecca Anderson | Dentist | 5915 High Street W, Portsmouth, VA 23703 | 2017-06-02 |
| 1881126019 | Anas Elmahdi | Specialist | 5205 Sweetbriar C., 5205 Sweetbriar C., Portsmouth, VA 23703 | 2017-03-28 |
| 1578003554 | Elyse Buttery | Nurse Practitioner | Mast One 1040 University Blvd, Suite 200, Portsmouth, VA 23703 | 2017-02-24 |
| 1376948349 | Charles Douglas Knight | Military Health Care Provider | Uss Maryland Ssbn 738, Fpo, AA 23703 | 2014-11-03 |
| 1689929382 | Positive Connections, Inc | Community/Behavioral Health | 3823d Meherrin River Reach, Portsmouth, VA 23703 | 2012-07-18 |
| 1225319874 | Sanaz Namin | Pharmacist | 5601 High Street, Porstmouth, VA 23703 | 2011-09-08 |
| 1295029767 | Maggie Jackson | Dental Hygienist | 4000 Coast Guard Blvd., Portsmouth, VA 23703 | 2011-06-02 |
| 1679804892 | Amy Kathleenn Gaspar | Specialist/Technologist, Other | 4113 Pendleton Rd, Portsmouth, VA 23703 | 2010-01-28 |
| Find all providers in zip 23703 | ||||
| Taxonomy Code | 261QM1100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Military/U.S. Coast Guard Outpatient |
| The Defense Health Program or U.S. Coast Guard funded "fixed" facilities or distinct parts of a facility, providing outpatient medical and dental services, primarily for Uniformed Services beneficiaries. A "fixed" facility is a non-temporary, non-deployed facility. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the "fixed" facility. It includes, as examples, the institutional portion of outpatient encounters (except Ambulatory Procedure Visits), supplies issued (e.g., glasses, ostomy supplies, crutches), and radiology and laboratory studies. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: title modified, definition added; 7/1/2006 title modified, definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275581415 | Branch Medical Clinic Portsmouth | Clinic/Center | 1 Ayers Circle Bldg. H-1, Portsmouth Naval Shipyard, Portsmouth, NH 03804-5000 | 2006-05-04 |
| 1821135658 | Branch Medical Clinic Naval Shipyard Norfolk | Clinic/Center | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2007-01-31 |
| 1881730265 | Branch Medical Clinic Yorktown | Clinic/Center | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2007-01-30 |
| 1629114004 | Branch Medical Clinic Oceana | Clinic/Center | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2007-01-30 |
| 1407992894 | Branch Medical Clinic Sewells Point | Clinic/Center | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2007-01-30 |
| 1861538258 | Tricare Medical Clinic Chesapeake | Clinic/Center | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2007-01-30 |
| 1558407734 | Branch Medical Clinic Little Creek | Clinic/Center | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2007-01-29 |
| 1518003797 | Tricare Medical Clinic Virginia Beach | Clinic/Center | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2007-01-29 |
| 1528104494 | Branch Medical Clinic Chesapeake | Clinic/Center | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2007-01-29 |
| 1740326545 | Branch Medical Clinic Dam Neck | Clinic/Center | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2007-01-29 |
| Find all providers in PORTSMOUTH | ||||
| City | PORTSMOUTH |
| Zip Code | 23703 |
Please comment or provide details below to improve the information on ISC PORTSMOUTH HEALTH SERVICES DIVISION USCG.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.