NPIMap

Organization Active NPI

Centra Medical Group, LLC

Doing business as Centra Medical Group Stroobants Cardiovascular Center

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Lynchburg, VA
National Provider Identifier
1184964124
Registry record updated Jul 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
Legal business name
CENTRA MEDICAL GROUP, LLC
Doing business as
Centra Medical Group Stroobants Cardiovascular Center
Practice address
2410 Atherholt Rd
Lynchburg, VA 24501-2148
Phone
(434) 200-5252
NPI assigned
Feb 28, 2013
Last updated
Jul 3, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
CENTRA MEDICAL GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 3, 2013

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

Authorized official

Name
Lewis Addison
Title
Sr VP Cfo
Phone
(434) 200-3656

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X NU Primary

Addresses

Primary practice location

2410 Atherholt Rd
Lynchburg, VA 24501-2148

Mailing address

2010 Atherholt Rd
Lynchburg, VA 24501-1106

Other names 1

  • Centra Medical Group Stroobants Cardiovascular Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

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
O20160224000056 VA Part A Provider - Hospital 6002719713 6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lynchburg, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184964124. Details of each certification follow.

Hospital certification: CCN 490021

Legal name
CENTRA HEALTH, INC
Doing business as
VA BAPTIST LYNCHBURG GENERAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Oct 20, 2010
Beds
519
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
3300 Rivermont Ave
Lynchburg, VA 24503-2030
Other Hospital Practice Location
Hospital subgroups
Acute care

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 39

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

View all 39

Care Compare: Hospital

Medicare Care Compare
Listed as
Centra Health - Lynchburg Gen HospitalCCN 490021 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

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 24

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

View all 24

Ownership & related parties

All disclosed owners & managing parties 18

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
John Fees Individual Corporate DirectorBoard Member Jan 1, 2023
Robert Tonkinson Individual Corporate OfficerCfo Jan 1, 2025
Gloria Witt Individual Corporate DirectorBoard Member Jan 1, 2023
Pamela S Bradford Individual Corporate Director Jan 1, 2025
Todd Irby Individual Corporate Director Jan 1, 2018
Peter a Caprise Individual Corporate Director Oct 19, 2018
Cynthia D Gunnoe Individual Corporate DirectorBoard Member Jan 1, 2023
Gary Mignogna Individual Corporate Director Jan 1, 2022
Kemper Beasley Individual Corporate Director Jan 1, 2022
Richard J Tugman Individual Corporate OfficerCeo Jan 1, 2025
Bonnie Svrcek Individual Corporate Director Jan 1, 2022
Clinton S Beverly Individual Corporate Director Jan 1, 2022
Cameron Patterson Individual Corporate Director Jan 1, 2025
Amy Gallagher Individual Corporate Director Jan 1, 2024
Thomas Nygaard Individual Corporate Officer Jan 1, 2022
Geeta Rakheram Individual Corporate Director Jan 1, 2022
Timothy Fritz Individual W-2 Managing Employee Apr 30, 2019
Rosana Chaidez Individual Corporate Director Jan 1, 2026

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 4

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.

Affiliated clinicians 1,123

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 1,123

NPI Registry JSON

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

{
    "created_epoch": "1362009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372809600000",
    "number": "1184964124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2010 ATHERHOLT RD",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245011106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2410 ATHERHOLT RD",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245012148",
            "telephone_number": "434-200-5252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRA MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTRA MEDICAL GROUP, LLC",
        "enumeration_date": "2013-02-28",
        "last_updated": "2013-07-03",
        "status": "A",
        "authorized_official_last_name": "ADDISON",
        "authorized_official_first_name": "LEWIS",
        "authorized_official_title_or_position": "SR VP CFO",
        "authorized_official_telephone_number": "434-200-3656"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Centra Medical Group Stroobants Cardiovascular Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lynchburg, VA

Sources for this page

Verify at the official NPI Registry.