NPIMap

Organization Active NPI

Southside Community Hospital Inc.

  • Home Health Agency
  • Farmville, VA
National Provider Identifier
1710056387
Registry record updated Apr 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
SOUTHSIDE COMMUNITY HOSPITAL INC.
Practice address
1705 E. 3Rd St.
Farmville, VA 23901-1199
Phone
(434) 315-5000
NPI assigned
Nov 7, 2006
Last updated
Apr 25, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2025

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

Authorized official

Name
Doug Davenport
Title
Cfo
Phone
(434) 200-4708

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X VA Primary

Addresses

Primary practice location

1705 E. 3Rd St.
Farmville, VA 23901-1199

Mailing address

PO Box 41000
Lynchburg, VA 24506-4100
Phone (434) 315-5000

Other identifiers 7

IdentifierTypeStateIssuer
1520OtherGENTIVA CARECENTRIX
=========OtherTRICARE (HEALTHNET FED)
=========OtherHUMANA GOLD CHOICE
004970551MedicaidVA
59075OtherVACARENET(MEDICAID HMO)
780021OtherVAANTHEM BCBS
20066OtherVAOPTIMA FAMILY CARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140822002596 VA Part A Provider - Home Health Agency 6305756297 Practice locations: Farmville, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710056387. Details of each certification follow.

Home health agency certification: CCN 497055

Legal name
SOUTHSIDE COMMUNITY HOSPITAL, INC.
Doing business as
CENTRA HOME HEALTH
Certification status
Active
Provider type (POS)
Home health agency
Participating since
May 10, 1985
Last certification
Jun 27, 2018
Ownership / control type
Non-Profit
Organization structure
CorporationNon-profit
Enrollment address
1705 E 3Rd St
Farmville, VA 23901-2938

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Home health agency

Medicare Care Compare
Listed as
Centra Home HealthCCN 497055 · All quality measures
Overall star rating
4 of 5
Ownership
Non-Profit
Certified
May 10, 1985
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Ray Wilson MD5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1705 E Third St
Farmville, VA 23901
Phone (434) 315-2992

711 Oak St
Farmville, VA 23901
Phone (804) 315-2562

Ownership & related parties

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Heather R Weeks Individual W-2 Managing Employee Jan 9, 2017
Robert Tonkinson Individual Corporate OfficerCfo Jan 1, 2025
Calvin Gray Individual Corporate DirectorBoard Member Jan 1, 2011 100%
Sharon Harrup Individual Corporate DirectorBoard Member Jan 1, 2011 100%
Centra Health, Inc Organization, Lynchburg, VA Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2025 100%
Timothy Fritz Individual W-2 Managing EmployeeController Jan 1, 2022

Owners & managing parties with NPI records 6

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Centra Health Inc

    dba Virginia Baptist Hosp Acute Psych

    • Psychiatric Hospital Unit
    • Lynchburg, VA
    • NPI 1023112331

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Centra Health Inc

    dba Centra Health Hospice of the Hills

    • Community Based Hospice Care Agency
    • Lynchburg, VA
    • NPI 1396849501

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Centra Health Inc

    dba Centra Health Home Health

    • Home Health Agency
    • Lynchburg, VA
    • NPI 1578667887

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Centra Health Inc
    • Durable Medical Equipment & Medical Supplies
    • Lynchburg, VA
    • NPI 1578738225

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Centra Health Inc
    • General Acute Care Hospital
    • Lynchburg, VA
    • NPI 1770693939

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Centra Health Inc

    dba Virginia Baptist Hosp Acute Rehab

    • Rehabilitation Hospital Unit
    • Lynchburg, VA
    • NPI 1932203247

    5% Or Greater Direct Ownership Interest

    CMS ownership

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

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.

Affiliated clinicians 25

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745539200000",
    "number": "1710056387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 41000",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245064100",
            "telephone_number": "434-315-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 E. 3RD ST.",
            "city": "FARMVILLE",
            "state": "VA",
            "postal_code": "239011199",
            "telephone_number": "434-315-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE COMMUNITY HOSPITAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2025-04-25",
        "certification_date": "2025-04-18",
        "status": "A",
        "authorized_official_last_name": "DAVENPORT",
        "authorized_official_first_name": "DOUG",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "434-200-4708"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GENTIVA CARECENTRIX",
            "identifier": "1520",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE (HEALTHNET FED)",
            "identifier": "=========",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA GOLD CHOICE",
            "identifier": "=========",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004970551",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARENET(MEDICAID HMO)",
            "identifier": "59075",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "780021",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTIMA FAMILY CARE",
            "identifier": "20066",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmville, VA

Sources for this page

Verify at the official NPI Registry.