NPIMap

Organization Active NPI

Dominion Health Medical Assoc

Doing business as Sentara Chase City Family Medicine

  • Legal Medicine
  • Chase City, VA
National Provider Identifier
1689772238
Registry record updated Feb 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Legal MedicineTaxonomy code 173000000X
License
0101032102 Issued in VA
Legal business name
DOMINION HEALTH MEDICAL ASSOC
Doing business as
Sentara Chase City Family Medicine
Practice address
946 N. Main St
Chase City, VA 23924
Phone
(434) 372-5141
Fax
(434) 517-3887
NPI assigned
Sep 20, 2006
Last updated
Feb 11, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2015

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Legal Medicine 173000000X 0101032102 VA Primary

Addresses

Primary practice location

946 N. Main St
Chase City, VA 23924

Mailing address

P.O. Box 860
South Boston, VA 24592
Phone (434) 517-3513

Other identifiers 1

IdentifierTypeStateIssuer
007610114MedicaidVA

Other names 1

  • Sentara Chase City Family 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

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423612800000",
    "number": "1689772238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 860",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "24592",
            "telephone_number": "434-517-3513",
            "fax_number": "434-517-3887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "946 N. MAIN ST",
            "city": "CHASE CITY",
            "state": "VA",
            "postal_code": "23924",
            "telephone_number": "434-372-5141",
            "fax_number": "434-517-3887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOMINION HEALTH MEDICAL ASSOC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2015-02-11",
        "status": "A",
        "authorized_official_last_name": "HAZELWOOD",
        "authorized_official_first_name": "CECIL",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "MANAGER (SDHG)",
        "authorized_official_telephone_number": "434-517-3515"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": "VA",
            "license": "0101032102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007610114",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sentara Chase City Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chase City, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2015; 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.