NPIMap

Organization Active NPI

Sentara Medical Group

  • Pediatrics Physician
  • Virginia Beach, VA
National Provider Identifier
1295957033
Registry record updated Dec 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
SENTARA MEDICAL GROUP
Practice address
2301 General Booth Blvd
Ste B
Virginia Beach, VA 23456-7755
Phone
(757) 395-1920
Fax
(757) 963-5501
NPI assigned
May 2, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2014

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
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

2301 General Booth Blvd
Ste B
Virginia Beach, VA 23456-7755

Mailing address

2301 General Booth Blvd
Ste B
Virginia Beach, VA 23456-7755
Phone (757) 395-1920

Other names 1

  • Sentara Pediatric Physicians 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
49D0997393Sentara Pediatric Physicians - Nimmo2301 General Booth Boulevard -Suite B, Virginia Beach, VA 23456Certificate of waiverMar 13, 2028

National Provider Directory

National Provider Directory

Locations

2301 General Booth Blvd
Ste B
Virginia Beach, VA 23456
Phone (757) 395-1920

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418688000000",
    "number": "1295957033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 GENERAL BOOTH BLVD",
            "address_2": "STE B",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234567755",
            "telephone_number": "757-395-1920",
            "fax_number": "757-963-5501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 GENERAL BOOTH BLVD",
            "address_2": "STE B",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234567755",
            "telephone_number": "757-395-1920",
            "fax_number": "757-963-5501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENTARA MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-02",
        "last_updated": "2014-12-16",
        "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": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sentara Pediatric Physicians",
            "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 Dec 16, 2014; 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.