NPIMap

Organization Active NPI

Centercare Family Practice, LLC

Doing business as Pedsplus Primary Care

  • Family Medicine Physician
  • Fredericksburg, VA
National Provider Identifier
1497106504
Registry record updated Dec 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CENTERCARE FAMILY PRACTICE, LLC
Doing business as
Pedsplus Primary Care
Practice address
1300 Emancipation Hwy
Fredericksburg, VA 22401-4600
Phone
(540) 289-2273
Fax
(540) 699-0214
NPI assigned
Jun 29, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2022

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

Authorized official

Name
Mickelina Laurore, FNPNPI 1275908006
Title
Manager
Phone
(239) 691-5450

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X VA Primary

Addresses

Primary practice location

1300 Emancipation Hwy
Fredericksburg, VA 22401-4600

Mailing address

1010 W Kensington Cir
Fredericksburg, VA 22401-8003
Phone (239) 691-5450

Other names 1

  • PEDSPLUS PRIMARY CARE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180213003028 VA Part B Supplier - Clinic/Group Practice 1254691173 Receives reassigned benefits from 5 practitioners
Practice locations: King George, VA

National Provider Directory

National Provider Directory

Locations

1300 Emancipation Hwy
Fredericksburg, VA 22401
Phone (540) 289-2273

621 Emancipation Hwy
#11B
Fredericksburg, VA 22401

15521 Real Estate Ave
Fl 1
King George, VA 22485

8163 Kings Hwy
King George, VA 22485
Phone (540) 289-2273

4207 Germanna Hwy
Ste 3
Locust Grove, VA 22508

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1467158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672358400000",
    "number": "1497106504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 W KENSINGTON CIR",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224018003",
            "telephone_number": "239-691-5450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 EMANCIPATION HWY",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224014600",
            "telephone_number": "540-289-2273",
            "fax_number": "540-699-0214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTERCARE FAMILY PRACTICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-29",
        "last_updated": "2022-12-30",
        "certification_date": "2022-12-30",
        "status": "A",
        "authorized_official_last_name": "LAURORE",
        "authorized_official_first_name": "MICKELINA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "239-691-5450",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PEDSPLUS PRIMARY CARE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PEDSPLUS PRIMARY CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fredericksburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2022; 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.