NPIMap

Organization Active NPI

Dominion Health Medical Associates LTD

Doing business as Sentara Behavioral Health Specialists

  • Community/Behavioral Health Agency
  • South Boston, VA
National Provider Identifier
1215411483
Registry record updated Sep 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
DOMINION HEALTH MEDICAL ASSOCIATES LTD
Doing business as
Sentara Behavioral Health Specialists
Practice address
504 Wilborn Ave
South Boston, VA 24592-3120
Phone
(434) 517-3400
NPI assigned
Sep 24, 2018
Last updated
Sep 24, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2018

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

Authorized official

Name
Cecil Hazelwood
Title
Manager/DHG
Phone
(434) 517-3515

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

504 Wilborn Ave
South Boston, VA 24592-3120

Mailing address

PO Box 860
South Boston, VA 24592-0860

Other names 1

  • SENTARA BEHAVIORAL HEALTH SPECIALISTS Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041206000840 VA Part B Supplier - Clinic/Group Practice 1254311558 Receives reassigned benefits from 91 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: South Boston, VA

Other NPIs on the same Medicare enrollment 17

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

View all 17

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
49D2160186Sentara Behavioral Health Specialists504 Wilborn Ave 5TH Floor, South Boston, VA 24592Certificate of waiverJan 6, 2027

National Provider Directory

National Provider Directory
Tax ID family
Clarksville Family Practice7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

504 Wilborn Ave
South Boston, VA 24592
Phone (434) 517-3400

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1537747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537747200000",
    "number": "1215411483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 860",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245920860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 WILBORN AVE",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245923120",
            "telephone_number": "434-517-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOMINION HEALTH MEDICAL ASSOCIATES LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-24",
        "last_updated": "2018-09-24",
        "status": "A",
        "authorized_official_last_name": "HAZELWOOD",
        "authorized_official_first_name": "CECIL",
        "authorized_official_title_or_position": "MANAGER/DHG",
        "authorized_official_telephone_number": "434-517-3515"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SENTARA BEHAVIORAL HEALTH SPECIALISTS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Boston, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.