NPIMap

Organization Active NPI

Centra Health Professional Services LLC

  • Internal Medicine Physician
  • Lynchburg, VA
National Provider Identifier
1104093822
Registry record updated May 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CENTRA HEALTH PROFESSIONAL SERVICES LLC
Practice address
1901 Thomson Dr
Lynchburg, VA 24501-1008
Phone
(434) 200-3908
NPI assigned
May 12, 2008
Organization subpart
Yes
Parent organization
CENTRA HEALTH PROFESSIONAL SERVICES LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 12, 2008

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

Authorized official

Name
Tammy Tweedy
Title
Director
Phone
(434) 200-5047

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

1901 Thomson Dr
Lynchburg, VA 24501-1008

Mailing address

1204 Fenwick Dr
Lynchburg, VA 24502-2112

Other names 1

  • Lynchburg Internal Medicine A Centra Health Affiliate Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051230000147 VA Part B Supplier - Clinic/Group Practice 4789606088 Receives reassigned benefits from 865 practitioners
37 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 37

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 37

National Provider Directory

National Provider Directory
Tax ID family
Centra Health Professional Services106 organizations share this tax ID, including this one
Part of
Centra Health Professional Services

Organizations with this tax ID in the same state 22

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 22

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1210550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210550400000",
    "number": "1104093822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1204 FENWICK DR",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245022112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 THOMSON DR",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245011008",
            "telephone_number": "434-200-3908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRA HEALTH PROFESSIONAL SERVICES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTRA HEALTH PROFESSIONAL SERVICES LLC",
        "enumeration_date": "2008-05-12",
        "last_updated": "2008-05-12",
        "status": "A",
        "authorized_official_last_name": "TWEEDY",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "434-200-5047"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lynchburg Internal Medicine A Centra Health Affiliate",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lynchburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2008; 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.