CENTRA MEDICAL GROUP, LLC (NPI# 1144880782) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144880782 |
| Entity Type | Organization |
| Organization Name | CENTRA MEDICAL GROUP, LLC |
| Practice Address |
2410 Atherholt Rd Lynchburg VA 24501-2148 |
| Mailing Address |
1937 Thomson Dr Lynchburg VA 24501-1008 |
| Practice Telephone | 4342005047 |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2019-06-17 |
| Authorized Official Name | JOSHUA LARKIN (PAYER CREDENTIALING MANAGER) |
| Authorized Official Telephone | 4342005047 |
| Is Organization Subpart | Y |
| Parent Organization Name | CENTRA MEDICAL GROUP, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| CMG Vascular Surgery | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326682980 | Centra Medical Group, LLC | Family Medicine | 3300 Rivermont Ave, Lynchburg, VA 24503-2030 | 2019-11-06 |
| 1932685526 | Centra Medical Group, LLC | Anesthesiology | 3300 Rivermont Ave, Lynchburg, VA 24503-2030 | 2018-07-17 |
| 1548750052 | Centra Medical Group, LLC | Family Medicine | 1901 Tate Springs Rd, Lynchburg, VA 24501-1109 | 2018-05-10 |
| 1376033886 | Centra Medical Group, LLC | Family Medicine | 1901 Tate Springs Rd, Lynchburg, VA 24501-1109 | 2018-05-10 |
| 1912434663 | Centra Medical Group, LLC | Family Medicine | 2010 Atherholt Rd, Lynchburg, VA 24501-1106 | 2017-05-12 |
| 1518315902 | Centra Medical Group, LLC | Clinic/Center | 125 Nationwide Drive, Lynchburg, VA 24502-9998 | 2016-05-26 |
| 1649624164 | Centra Medical Group, LLC | Psychologist | 2010 Atherholt Rd, Lynchburg, VA 24501-1106 | 2016-04-21 |
| 1003260522 | Centra Medical Group, LLC | Anesthesiology | 2010 Atherholt Rd, Lynchburg, VA 24501-1106 | 2016-04-21 |
| 1295104347 | Centra Medical Group, LLC | Internal Medicine | 1613 Oakwood St, Suite 201, Bedford, VA 24523-1213 | 2015-09-18 |
| 1720463821 | Centra Medical Group, LLC | Psychiatry & Neurology | 1933 Thomson Dr, Lynchburg, VA 24501-1008 | 2015-07-30 |
| Street Address |
2410 ATHERHOLT RD |
| City | LYNCHBURG |
| State | VA |
| Zip Code | 24501-2148 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255312609 | Kenneth E Saum | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2410 Atherholt Rd, Lynchburg, VA 24501-2148 | 2005-11-10 |
| 1841808052 | Connor David Middlekauff | Physician Assistant | 2410 Atherholt Rd, Lynchburg, VA 24501-2148 | 2020-07-14 |
| 1235762915 | Jennifer L Mccoy | Nurse Practitioner | 2410 Atherholt Rd, Lynchburg, VA 24501-2148 | 2020-02-20 |
| 1043855356 | Virginia Leigh Blevins | Nurse Practitioner | 2410 Atherholt Rd, Lynchburg, VA 24501-2148 | 2019-11-11 |
| 1831747955 | Blakley Walker Sproles | Physician Assistant | 2410 Atherholt Rd, Lynchburg, VA 24501-2148 | 2019-09-02 |
| 1508411323 | James Mark Marcouillier | Physician Assistant | 2410 Atherholt Rd, Lynchburg, VA 24501-2148 | 2019-08-08 |
| 1962062109 | Taylor Grasser | Physician Assistant | 2410 Atherholt Rd, Lynchburg, VA 24501-2148 | 2019-06-19 |
| 1669949277 | Abigail Jean Newton | Nurse Practitioner | 2410 Atherholt Rd, Lynchburg, VA 24501-2148 | 2018-11-01 |
| 1245707140 | John N Smiley | Nurse Practitioner | 2410 Atherholt Rd, Lynchburg, VA 24501-2148 | 2018-10-29 |
| 1891279154 | Julia Norton | Physician Assistant | 2410 Atherholt Rd, Lynchburg, VA 24501-2148 | 2018-09-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720606957 | Evidence Based Counseling Solutions | Speech-Language Pathologist | 302 Oakley Ave, Lynchburg, VA 24501 | 2020-07-14 |
| 1740805506 | Ryan Buschmann | Physical Therapist | 2400 Lakeside Drivve, Suite 602f, Lynchburg, VA 24501 | 2020-06-08 |
| 1528525276 | Julia M Mcauley-gonzalez | Nurse Practitioner | Cvfp Immediate Care - Airport, 14005 Wards Rd - Suite A, Lynchburg, VA 24501 | 2019-02-28 |
| 1548732795 | Morgan Rose Nails | Chiropractor | 3012 Forest Hills Circle, Lynchburg, VA 24501 | 2018-12-28 |
| 1407346935 | Belva Shelor | Psychologist | 1201 Floyd Street, Lynchburg, VA 24501 | 2018-05-10 |
| 1770092447 | Bio-medical Applications of Virginia, Inc. | Clinic/Center | 3204 Old Forest Rd, Lynchburg, VA 24501 | 2017-09-26 |
| 1447774518 | Restoring Peace Counseling Services | Clinic/Center | 3311 Old Forest Rd Ste 101, Lynchburg, VA 24501 | 2017-08-01 |
| 1427578335 | Vinh Thinh T Huynh | Family Medicine | 2323 Memorial Avenue, Suite #10, Lynchburg, VA 24501 | 2017-06-21 |
| 1811436769 | Jordan Legendre | Student in an Organized Health Care Education/Training Program | 2900 Weeping Willow Drive, Apt. I, Lynchburg, VA 24501 | 2017-02-13 |
| 1114465861 | Shanika Harris | Specialist/Technologist | 1501 Lakeside Drive, Lynchburg, VA 24501 | 2017-02-02 |
| Find all providers in zip 24501 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700170412 | Centra Health Professional Services, LLC | Surgery | 2410 Atherholt Rd, Lynchburg, VA 24501-2148 | 2011-05-31 |
| 1386825040 | Centra Medical Group, LLC | Surgery | 1911 Thomson Dr, Lynchburg, VA 24501-1008 | 2007-11-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124670930 | Usa Vein Clinics of Chantilly LLC | Surgery | 3914 Centreville Rd Ste 125, Chantilly, VA 20151-3289 | 2019-07-11 |
| 1285115998 | Sentara Medical Group | Surgery | 397 Little Neck Rd Ste 110, Virginia Beach, VA 23452-5774 | 2018-08-22 |
| 1629586417 | Sentara Medical Group | Surgery | 1051 Loftis Blvd Ste 210, Newport News, VA 23606-3069 | 2018-01-16 |
| 1942724620 | Sentara Medical Group | Surgery | 500 Sentara Cir Ste 100, Williamsburg, VA 23188-5727 | 2017-08-03 |
| 1972980761 | Carlos Jose Torres-medina | Surgery | 500 J Clyde Morris Blvd # 603, Newport News, VA 23601-1929 | 2015-04-30 |
| 1306280128 | Justin Marc Milligan | Surgery | 397 Little Neck Rd Ste 120, Virginia Beach, VA 23452-5774 | 2013-04-23 |
| 1578817938 | Clinch Valley Vascular Surgical Assoc., Pllc | Surgery | 6719 Gov. G.c. Peery Highway, Suite 2600, Richlands, VA 24641 | 2012-11-06 |
| 1346503463 | Mid Atlantic Vascular Holding, LLC | Surgery | 1415 Eastridge Rd, Richmond, VA 23229-5501 | 2012-06-22 |
| 1265791297 | Vascular Surgery Group | Surgery | 850 Chistensen Court, Great Falls, VA 22066 | 2012-05-11 |
| 1902122922 | Hao Duy Pham | Surgery | 6719 Governor Gc Peery Hwy Ste 2600, Richlands, VA 24641 | 2010-04-15 |
| Find all providers with the same taxonomy | ||||
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| 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.