NPIMap

Organization Active NPI

Dominion Health Medical Assoc

Doing business as Sentara Imaging Services

  • Diagnostic Radiology Physician
  • South Boston, VA
National Provider Identifier
1487476628
Registry record updated Oct 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
DOMINION HEALTH MEDICAL ASSOC
Doing business as
Sentara Imaging Services
Practice address
2204 Wilborn Ave
South Boston, VA 24592-1645
Phone
(434) 517-3403
Fax
(434) 517-3686
NPI assigned
Oct 29, 2024
Last updated
Oct 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2024

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

Authorized official

Name
Doris Prince
Title
Director
Phone
(757) 983-5475

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

2204 Wilborn Ave
South Boston, VA 24592-1645

Mailing address

2204 Wilborn Ave
South Boston, VA 24592-1645
Phone (434) 517-3403

Other names 1

  • Sentara Imaging Services 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

National Provider Directory

National Provider Directory
Tax ID family
Dominion Medical Health Assoc7 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.

Practitioners & affiliated clinicians

Practitioners 5

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": "1730160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730160000000",
    "number": "1487476628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2204 WILBORN AVE",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245921645",
            "telephone_number": "434-517-3403",
            "fax_number": "434-517-3686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2204 WILBORN AVE",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245921645",
            "telephone_number": "434-517-3403",
            "fax_number": "434-517-3686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOMINION HEALTH MEDICAL ASSOC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-29",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A",
        "authorized_official_last_name": "PRINCE",
        "authorized_official_first_name": "DORIS",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "757-983-5475"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sentara Imaging Services",
            "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 Oct 29, 2024; 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.