NPIMap

Organization Active NPI

Centra Health Professional Services, LLC

Doing business as Brookneal Family Medical Center

  • Family Medicine Physician
  • Brookneal, VA
National Provider Identifier
1659315943
Registry record updated Mar 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CENTRA HEALTH PROFESSIONAL SERVICES, LLC
Doing business as
Brookneal Family Medical Center
Practice address
104 Carolina Ave
Brookneal, VA 24528-2643
Phone
(434) 376-2325
NPI assigned
Jun 16, 2006
Last updated
Mar 4, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
CENTRA HEALTH PROFESSIONAL SERVICES, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 4, 2008

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

Authorized official

Name
Tammy Tweedy
Title
Director
Phone
(434) 947-5047

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

104 Carolina Ave
Brookneal, VA 24528-2643

Mailing address

1204 Fenwick Dr
Lynchburg, VA 24502-2112

Other names 1

  • Brookneal Family Medical Center 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

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": "1150416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204588800000",
    "number": "1659315943",
    "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": "104 CAROLINA AVE",
            "city": "BROOKNEAL",
            "state": "VA",
            "postal_code": "245282643",
            "telephone_number": "434-376-2325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRA HEALTH PROFESSIONAL SERVICES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTRA HEALTH PROFESSIONAL SERVICES, LLC",
        "enumeration_date": "2006-06-16",
        "last_updated": "2008-03-04",
        "status": "A",
        "authorized_official_last_name": "TWEEDY",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "434-947-5047"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookneal Family Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brookneal, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 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.