NPIMap

Organization Active NPI

Centra Medical Group, LLC

Doing business as Piedmont Primecare-Centra Medical Group

  • Family Medicine Physician
  • Danville, VA
National Provider Identifier
1285931089
Registry record updated Nov 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CENTRA MEDICAL GROUP, LLC
Doing business as
Piedmont Primecare-Centra Medical Group
Practice address
404 Airport Dr
Suite a
Danville, VA 24540-5196
Phone
(434) 791-2612
NPI assigned
Feb 15, 2011
Last updated
Nov 14, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
CENTRA MEDICAL GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 14, 2012

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

404 Airport Dr
Suite a
Danville, VA 24540-5196

Mailing address

1204 Fenwick Dr
Lynchburg, VA 24502-2112

Other names 1

  • Piedmont Primecare-Centra Medical Group 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
Part of
Centra Medical Group LLC

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1297728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352851200000",
    "number": "1285931089",
    "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": "404 AIRPORT DR",
            "address_2": "SUITE A",
            "city": "DANVILLE",
            "state": "VA",
            "postal_code": "245405196",
            "telephone_number": "434-791-2612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRA MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTRA MEDICAL GROUP, LLC",
        "enumeration_date": "2011-02-15",
        "last_updated": "2012-11-14",
        "status": "A",
        "authorized_official_last_name": "ADDISON",
        "authorized_official_first_name": "LEWIS",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "434-200-3656"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Piedmont Primecare-Centra Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Danville, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2012; 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.