NPIMap

Organization Active NPI

Sentara Medical Group

Doing business as First Colonial Diagnostic Center

  • Diagnostic Radiology Physician
  • Virginia Beach, VA
National Provider Identifier
1053350322
Registry record updated Sep 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
SENTARA MEDICAL GROUP
Doing business as
First Colonial Diagnostic Center
Practice address
1080 First Colonial Rd
Suite 100
Virginia Beach, VA 23454-2406
Phone
(757) 395-6464
Fax
(757) 395-6490
NPI assigned
Jun 5, 2006
Last updated
Sep 23, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2011

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

Authorized official

Name
Mrs. Cindy A Taylor
Title
Manager
Phone
(757) 252-3344

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X NU Primary
Clinical Medical Laboratory 291U00000X 49D0981411 VA

Addresses

Primary practice location

1080 First Colonial Rd
Suite 100
Virginia Beach, VA 23454-2406

Mailing address

1080 First Colonial Rd
Suite 100
Virginia Beach, VA 23454-2406
Phone (757) 395-6464

Other identifiers 1

IdentifierTypeStateIssuer
P00393284OtherVARR MEDICARE PIN

Other names 1

  • First Colonial Diagnostic Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090707000515 VA Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 8921903923 Practice locations: Virginia Beach, VA

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316736000000",
    "number": "1053350322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1080 FIRST COLONIAL RD",
            "address_2": "SUITE 100",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234542406",
            "telephone_number": "757-395-6464",
            "fax_number": "757-395-6490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1080 FIRST COLONIAL RD",
            "address_2": "SUITE 100",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234542406",
            "telephone_number": "757-395-6464",
            "fax_number": "757-395-6490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENTARA MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-05",
        "last_updated": "2011-09-23",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "CINDY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "757-252-3344",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "VA",
            "license": "49D0981411",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PIN",
            "identifier": "P00393284",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "First Colonial Diagnostic Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Virginia Beach, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.