NPIMap

Organization Active NPI

Dominion Health Medical Assoc

Doing business as Sentara Occupational Medicine

  • Occupational Medicine Clinic/Center
  • South Boston, VA
National Provider Identifier
1568933182
Registry record updated Dec 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Medicine Clinic/CenterTaxonomy code 261QX0100X
Legal business name
DOMINION HEALTH MEDICAL ASSOC
Doing business as
Sentara Occupational Medicine
Practice address
101 Aubreys Loop
South Boston, VA 24592-5054
Phone
(434) 517-3879
NPI assigned
Dec 7, 2018
Last updated
Dec 7, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2018

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

Authorized official

Name
Cecil Hazelwood
Title
Manager
Phone
(434) 517-3515

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Medicine Clinic/Center 261QX0100X Primary

Addresses

Primary practice location

101 Aubreys Loop
South Boston, VA 24592-5054

Mailing address

PO Box 860
South Boston, VA 24592-0860

Other names 1

  • Sentara Occupational Medicine 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

Practitioners & affiliated clinicians

Practitioners 2

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": "1544140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544140800000",
    "number": "1568933182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 860",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245920860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 AUBREYS LOOP",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245925054",
            "telephone_number": "434-517-3879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOMINION HEALTH MEDICAL ASSOC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-07",
        "last_updated": "2018-12-07",
        "status": "A",
        "authorized_official_last_name": "HAZELWOOD",
        "authorized_official_first_name": "CECIL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "434-517-3515"
    },
    "taxonomies": [
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sentara Occupational Medicine",
            "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 Dec 7, 2018; 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.