SENTARA MEDICAL GROUP (NPI# 1629409156) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629409156 |
| Entity Type | Organization |
| Organization Name | SENTARA MEDICAL GROUP |
| Other Organization Name | DR. EUGENIA M. GRAY |
| Practice Address |
2790 Godwin Blvd Ste 205 Suffolk VA 23434-8151 |
| Practice Telephone | 7579347753 |
| Practice Fax Number | 7575351739 |
| Mailing Telephone | 7579347753 |
| Mailing Fax Number | 7575351739 |
| Enumeration Date | 2013-12-10 |
| Last Update Date | 2013-12-10 |
| Authorized Official Name | MRS. CINDY A TAYLOR (MANAGER) |
| Authorized Official Telephone | 7572523344 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Y00000X | Otolaryngology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | MEDICARE GROUP NUMBER | C02033 | 01 |
| Other Name | Type Code |
|---|---|
| Dr. Eugenia M. Gray | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811533375 | Sentara Medical Group | Internal Medicine | 1101 First Colonial Rd Ste 300, Virginia Beach, VA 23454-2409 | 2019-11-20 |
| 1285115998 | Sentara Medical Group | Surgery | 397 Little Neck Rd Ste 110, Virginia Beach, VA 23452-5774 | 2018-08-22 |
| 1336627207 | Sentara Medical Group | Emergency Medicine | 844 Kempsville Rd Ste 103, Norfolk, VA 23502 | 2018-08-02 |
| 1073010369 | Sentara Medical Group | Preventive Medicine | 2760 Godwin Blvd Ste 101, Suffolk, VA 23434-8501 | 2018-04-12 |
| 1376043489 | Sentara Medical Group | Internal Medicine | 301 Riverview Ave Ste 670, Norfolk, VA 23510-1065 | 2018-02-15 |
| 1629586417 | Sentara Medical Group | Surgery | 1051 Loftis Blvd Ste 210, Newport News, VA 23606-3069 | 2018-01-16 |
| 1558879346 | Sentara Medical Group | Family Medicine | 301 Riverview Ave Ste 930, Norfolk, VA 23510-1068 | 2018-01-16 |
| 1942724620 | Sentara Medical Group | Surgery | 500 Sentara Cir Ste 100, Williamsburg, VA 23188-5727 | 2017-08-03 |
| 1265954747 | Sentara Medical Group | Internal Medicine | 1933 Edwin Dr Ste 208a, Chesapeake, VA 23322-6531 | 2017-07-17 |
| 1487195111 | Sentara Medical Group | Clinical Medical Laboratory | 1933 Edwin Dr, Suite 104, Chesapeake, VA 23322-6531 | 2017-03-14 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | Sentara Medical Group | 835 Glenrock Road, Norfolk, Virginia 23502 |
| System for Award Management (SAM) Entities | SENTARA MEDICAL GROUP | 863 Glenrock Rd Ste 208, Norfolk, VA 23502-3701 |
| North Carolina Corporations | Sentara medical Group | 160 Mine Lake Ct Ste 200, Raleigh, NC 27615 |
| Street Address |
2790 GODWIN BLVD STE 205 |
| City | SUFFOLK |
| State | VA |
| Zip Code | 23434-8151 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497757835 | Benigno D Federici | Obstetrics & Gynecology | 2790 Godwin Blvd, Suite 360, Suffolk, VA 23434-8151 | 2005-08-15 |
| 1942757265 | Catherine Adickes | Registered Nurse | 2790 Godwin Blvd, Suite 305, Suffolk, VA 23434-8151 | 2016-09-02 |
| 1568918480 | Sentara Medical Group | Durable Medical Equipment & Medical Supplies | 2790 Godwin Blvd, Ste 355, Suffolk, VA 23434-8151 | 2016-08-31 |
| 1700259520 | Virginia Oncology Associates | Durable Medical Equipment & Medical Supplies | 2790 Godwin Blvd, Suite 101, Suffolk, VA 23434-8151 | 2015-11-02 |
| 1780013367 | Knox Audiology LLC | Audiologist | 2790 Godwin Blvd, Suite 205, Suffolk, VA 23434-8151 | 2013-11-05 |
| 1720428865 | Jason Rosenwald | Physician Assistant | 2790 Godwin Blvd, Suite 320, Suffolk, VA 23434-8151 | 2013-07-03 |
| 1093091175 | Mary Katherine Williams | Advanced Practice Midwife | 2790 Godwin Blvd, Suite 360, Suffolk, VA 23434-8153 | 2011-11-02 |
| 1609103902 | Sentara Medical Group | Internal Medicine | 2790 Godwin Blvd, Suite 225, Suffolk, VA 23434-8151 | 2009-11-06 |
| 1013150457 | Sentara Medical Group | Psychiatry & Neurology | 2790 Godwin Blvd, Suite 235, Suffolk, VA 23434-8151 | 2009-04-15 |
| 1154593176 | Theresa G Smith | Midwife | 2790 Godwin Blvd, Suite 360, Suffolk, VA 23434-8151 | 2008-03-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235780255 | Chiquita Savage | Home Health | You 1st Healthcare, 112 West Washington Street Suite 502, Suffolk, VA 23434 | 2019-09-20 |
| 1912561713 | Revivication Counseling Services | Counselor | 814 Cripple Creek Lane, Suffolk, VA 23434 | 2019-04-26 |
| 1558826958 | Nita Jenkins | Non-emergency Medical Transport (VAN) | 707 Gittings St. Suite 105, Suffolk, VA 23434 | 2019-02-10 |
| 1730660952 | Latrese L Riddick | Driver | 418 Jackson St, Suffolk, VA 23434 | 2018-08-25 |
| 1114411279 | Percilla D Zeno | Community Health Worker | 102 Niblick Cir, Suffolk, VA 23434 | 2018-06-21 |
| 1437652765 | Aprele Gaddie | Health Educator | 2769 Godwin Boulevard, Suffolk, VA 23434 | 2018-03-13 |
| 1598284283 | Domonic Teheran Scott | Driver | 102 Brewer Ave, Suffolk, VA 23434 | 2017-09-13 |
| 1578089397 | Nakia Shantel Francis | Nurse Practitioner | 2970 Godwin Blvd, Suite 320, Suffolk, VA 23434 | 2017-08-15 |
| 1679093009 | Daisy Mae Aba, LLC | Behavioral Analyst | 3212 Clearcreek Rd., Suffolk, VA 23434 | 2017-06-27 |
| 1114457736 | Better Care Family Homes | Day Training, Developmentally Disabled Services | 813 West Washington Street, Suffolk, VA 23434 | 2017-06-15 |
| Find all providers in zip 23434 | ||||
| Taxonomy Code | 207Y00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467533109 | Ear,nose&throat of Tidewater Inc | Otolaryngology | 2790 Godwin Blvd, Suite 205, Suffolk, VA 23434-8151 | 2006-10-18 |
| 1316982168 | John Patrick Lyle | Otolaryngology | 2790 Godwin Blvd, Suite 205, Suffolk, VA 23434-8151 | 2006-06-17 |
| 1649236233 | Edilberto Olarte Pelausa | Otolaryngology | 2000 Meade Parkway, Suffolk, VA 23434-4259 | 2006-04-24 |
| 1730145418 | Kevin David Meakin | Otolaryngology | 2000 Meade Parkway, Suffolk, VA 23434-4259 | 2006-04-22 |
| 1164485652 | Lorenz Frederick Lassen | Otolaryngology | 2000 Meade Parkway, Suffolk, VA 23434-4259 | 2006-04-07 |
| 1225010143 | Pierre Thomas Martin | Otolaryngology | 5818 Harbour View Blvd, Suite 230, Suffolk, VA 23435-3315 | 2005-11-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174005417 | Roanoke Valley Ent & Allergy PC | Otolaryngology | 2154 Mcvitty Rd, Second Floor, Roanoke, VA 24018 | 2018-09-04 |
| 1629459243 | Kevin James Quinn | Otolaryngology | 1200 E Broad St # 980257, Richmond, VA 23298 | 2015-06-10 |
| 1356778641 | Stat, LLC | Otolaryngology | 10812 Weather Vane Rd, Richmond, VA 23238-4161 | 2013-10-01 |
| 1134564073 | Ear, Nose, Throat & Allergy Consultants, PC | Otolaryngology | 26208 Lee Highway, Abingdon, VA 24211-7504 | 2013-05-06 |
| 1467790477 | Marco Aurelio Merida | Otolaryngology | 7216 Farm Meadow Ct, Mc Lean, VA 22101-5657 | 2013-01-25 |
| 1609142355 | Neelima Tummala | Otolaryngology | 1860 Town Center Dr Ste 420, Reston, VA 20190-5901 | 2012-03-27 |
| 1346512225 | John Laurence Manwaring | Otolaryngology | 7734 Retreat Ln, Warrenton, VA 20186-7546 | 2012-02-07 |
| 1508151887 | Jose Luis Mattos | Otolaryngology | 415 Ray C. Hunt Dr Ste 2200, Charlottesville, VA 22903-0001 | 2011-06-14 |
| 1982998852 | Blue Ridge Medical Management Corporation | Otolaryngology | 7021 W Lee Highway, Suite B, Rural Retreat, VA 24368-0000 | 2011-06-08 |
| 1609168327 | Jae Y Kim | Otolaryngology | 2200 Wilson Blvd Ste 102-219, Arlington, VA 22201-3397 | 2011-05-12 |
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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.