NPIMap

Organization Active NPI

Centra Health Professional Services, LLC

  • Urology Physician
  • Moneta, VA
National Provider Identifier
1497900047
Registry record updated Nov 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
CENTRA HEALTH PROFESSIONAL SERVICES, LLC
Practice address
1039 Mayberry Crossing Drive
Moneta, VA 24121
Phone
(540) 297-7840
NPI assigned
Nov 24, 2008
Organization subpart
Yes
Parent organization
CENTRA HEALTH PROFESSIONAL SERVICES, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 24, 2008

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

Authorized official

Name
Tammy Tweedy
Title
Regional Director
Phone
(434) 200-3656

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208800000X Primary

Addresses

Primary practice location

1039 Mayberry Crossing Drive
Moneta, VA 24121

Mailing address

1204 Fenwick Dr
Lynchburg, VA 24502-2112

Other names 1

  • Seven Hills Urology, A Centra Health Affiliate 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

1039 Mayberry Crossing Dr
Moneta, VA 24121
Phone (540) 297-7840

Practitioners & affiliated clinicians

Practitioners 9

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": "1227484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227484800000",
    "number": "1497900047",
    "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": "1039 MAYBERRY CROSSING DRIVE",
            "city": "MONETA",
            "state": "VA",
            "postal_code": "24121",
            "telephone_number": "540-297-7840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRA HEALTH PROFESSIONAL SERVICES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTRA HEALTH PROFESSIONAL SERVICES, LLC",
        "enumeration_date": "2008-11-24",
        "last_updated": "2008-11-24",
        "status": "A",
        "authorized_official_last_name": "TWEEDY",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "REGIONAL DIRECTOR",
        "authorized_official_telephone_number": "434-200-3656"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Seven Hills Urology, A Centra Health Affiliate",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moneta, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2008; 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.