NPIMap

Organization Active NPI

Sentara Medical Group

  • Clinical Medical Laboratory
  • Virginia Beach, VA
National Provider Identifier
1174766026
Registry record updated Nov 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
49D0981411 Issued in VA
Legal business name
SENTARA MEDICAL GROUP
Practice address
1080 First Colonial Rd
Suite 100a
Virginia Beach, VA 23454-2406
Phone
(757) 395-6464
NPI assigned
Apr 8, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 49D0981411 VA Primary

Addresses

Primary practice location

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

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
190002093OtherVAMEDICARE PIN
P00393284OtherVARR MEDICARE PIN

Other names 1

  • First Colonial Diagnostic Center Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D2318189Sentara Behavioral Health Specialists -1080 First Colonial Road, Suite 403, Virginia Beach, VA 23454Certificate of waiverFeb 5, 2027

National Provider Directory

National Provider Directory

Locations

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

NPI Registry JSON

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

{
    "created_epoch": "1239148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322438400000",
    "number": "1174766026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1080 FIRST COLONIAL RD",
            "address_2": "SUITE 100A",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234542406",
            "telephone_number": "757-395-6464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1080 FIRST COLONIAL RD",
            "address_2": "SUITE 100A",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234542406",
            "telephone_number": "757-395-6464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENTARA MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-08",
        "last_updated": "2011-11-28",
        "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": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "VA",
            "license": "49D0981411",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "190002093",
            "state": "VA"
        },
        {
            "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 Nov 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.