NPIMap

Organization Active NPI

Spectrum Transformation Group, LLC

  • Cognitive & Behavioral Psychologist
  • North Chesterfield, VA
National Provider Identifier
1174855985
Registry record updated Nov 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X
Legal business name
SPECTRUM TRANSFORMATION GROUP, LLC
Practice address
221 Stonebridge Plaza Ave Ste C
North Chesterfield, VA 23225-6972
Phone
(804) 378-6141
NPI assigned
Feb 3, 2010
Last updated
Nov 17, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2020

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

Authorized official

Name
Mr. Cedric Moore Jr., MBA
Title
Chief Executive Officer
Phone
(804) 317-4307

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X
Cognitive & Behavioral PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TB0200X Primary
Clinical Child & Adolescent PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC2200X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X

Addresses

Primary practice location

221 Stonebridge Plaza Ave Ste C
North Chesterfield, VA 23225-6972

Mailing address

221 Stonebridge Plaza Ave Ste C
North Chesterfield, VA 23225-6972
Phone (804) 378-6141

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101122000475 VA Part B Supplier - Clinic/Group Practice 8527253830 Receives reassigned benefits from 12 practitioners
Practice locations: North Chesterfield, VA

National Provider Directory

National Provider Directory
Tax ID family
Spectrum Transformation Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

11311 Business Center Dr
Ste C
North Chesterfield, VA 23236
Phone (804) 378-6141

11506 Allecingie Pkwy
Ste 2A
North Chesterfield, VA 23235
Phone (804) 378-6141

221 Stonebridge Plaza Ave
North Chesterfield, VA 23225
Phone (804) 378-6141

221 Stonebridge Plaza Ave
Ste C
North Chesterfield, VA 23225
Phone (804) 378-6141

Practitioners & affiliated clinicians

Practitioners 51

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 51

NPI Registry JSON

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

{
    "created_epoch": "1265155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605571200000",
    "number": "1174855985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 STONEBRIDGE PLAZA AVE STE C",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232256972",
            "telephone_number": "804-378-6141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 STONEBRIDGE PLAZA AVE STE C",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232256972",
            "telephone_number": "804-378-6141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM TRANSFORMATION GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-03",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-17",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "CEDRIC",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "804-317-4307",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Chesterfield, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2020; 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.