NPIMap

Individual provider Active NPI

Sebastian J Ksionski, MD

  • Pain Medicine Physician
  • Lynchburg, VA
National Provider Identifier
1033120852
Registry record updated Aug 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
License
0101268046 Issued in VA
Practice address
1330 Oak LN
Lynchburg, VA 24503
Phone
(434) 200-4175
NPI assigned
Aug 10, 2006
Last updated
Aug 3, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 11013088 IN
Sports Medicine (Family Medicine) Physician 207QS0010X 55415 MN
Sports Medicine (Family Medicine) Physician 207QS0010X 0101268046 VA
Pain Medicine Physician 208VP0000X 0101268046 VA Primary
Interventional Pain Medicine Physician 208VP0014X 54712 MN

Addresses

Primary practice location

1330 Oak LN
Lynchburg, VA 24503

Mailing address

1330 Oak LN
Lynchburg, VA 24503-2513
Phone (434) 200-4175

Other practice location 1

2010 Atherholt Road
Attn Emily Moore
Lynchburg, VA 24501
Phone (434) 200-2539

Other practice location 2

2010 Atherholt Road
Attn Emily Moore
Lynchburg, VA 24501
Phone (434) 200-2539

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191220002281 VA Practitioner - Pain ManagementPractitioner - Family PracticePractitioner - Sports Medicine 6608929047 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pain ManagementAlso: Family Practice, Sports Medicine
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centra Medical Group LLCGroup PAC ID 4789606088, 709 clinicians

Practice addresses (Care Compare)

935 S Main St
Farmville, VA 23901-2211
Phone (434) 315-5340

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.16 of 100Reported as apm
Quality
83.58
Promoting interoperability
94
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
11013088INMDFamily Medicine Physician
0101268046VAMDPain Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centra Medical Group, LLC Family Medicine CurrentSince Dec 1, 2019 Accepting new patients
Fort Wayne Medical Education Program Family Medicine PastSince Sep 1, 2024 Accepting new patients
Hennepin Healthcare System, Inc Interventional Pain Medicine Past Accepting new patients
Centra Health Professional Services, LLC Family Medicine Past Accepting new patients
Hennepin Faculty Associates Past Accepting new patients

Locations

800 Oak St
Farmville, VA 23901
Phone (434) 315-2530

935 S Main St
Farmville, VA 23901
Phone (434) 315-5340

1330 Oak Ln
Lynchburg, VA 24503
Phone (434) 200-4072

1901 Tate Springs Rd
Lynchburg, VA 24501
Phone (434) 200-3101

1937 Thomson Dr
Lynchburg, VA 24501
Phone (434) 200-6484

2010 Atherholt Rd
Lynchburg, VA 24501
Phone (434) 200-3656

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596412800000",
    "number": "1033120852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1330 OAK LN",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245032513",
            "telephone_number": "434-200-4175",
            "fax_number": "434-200-4321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 OAK LN",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "24503",
            "telephone_number": "434-200-4175"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2010 Atherholt Road",
            "address_2": "Attn Emily Moore",
            "address_purpose": "LOCATION",
            "city": "Lynchburg",
            "state": "VA",
            "postal_code": "24501",
            "country_code": "US",
            "telephone_number": "434-200-2539",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2010 Atherholt Road",
            "address_2": "Attn Emily Moore",
            "address_purpose": "LOCATION",
            "city": "Lynchburg",
            "state": "VA",
            "postal_code": "24501",
            "country_code": "US",
            "telephone_number": "434-200-2539",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KSIONSKI",
        "first_name": "SEBASTIAN",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-10",
        "last_updated": "2020-08-03",
        "certification_date": "2020-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "11013088",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "MN",
            "license": "55415",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "VA",
            "license": "0101268046",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "VA",
            "license": "0101268046",
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "MN",
            "license": "54712",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynchburg, VA

Sources for this page

Verify at the official NPI Registry.