NPIMap

Organization Active NPI

Centra Medical Group, LLC

Doing business as Centra Medical Group Surgical Specialists

  • Vascular Surgery Physician
  • Lynchburg, VA
National Provider Identifier
1386825040
Registry record updated Oct 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
CENTRA MEDICAL GROUP, LLC
Doing business as
Centra Medical Group Surgical Specialists
Practice address
1911 Thomson Dr
Lynchburg, VA 24501-1008
Phone
(434) 200-3901
NPI assigned
Nov 21, 2007
Last updated
Oct 16, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
CENTRA MEDICAL GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 16, 2014

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

Authorized official

Name
Lewis Addison
Title
Director
Phone
(434) 200-5047

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X NU Primary

Addresses

Primary practice location

1911 Thomson Dr
Lynchburg, VA 24501-1008

Mailing address

2010 Atherholt Rd
Lynchburg, VA 24501-1106

Other names 1

  • Centra Medical Group Surgical Specialists 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
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

Locations

1911 Thomson Dr
Lynchburg, VA 24501
Phone (434) 200-3901

NPI Registry JSON

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

{
    "created_epoch": "1195603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413417600000",
    "number": "1386825040",
    "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": "1911 THOMSON DR",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245011008",
            "telephone_number": "434-200-3901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRA MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTRA MEDICAL GROUP, LLC",
        "enumeration_date": "2007-11-21",
        "last_updated": "2014-10-16",
        "status": "A",
        "authorized_official_last_name": "ADDISON",
        "authorized_official_first_name": "LEWIS",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "434-200-5047"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Centra Medical Group Surgical Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lynchburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2014; 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.