Sentara Obici Ambulatory Surgery, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SENTARA OBICI AMBULATORY SURGERY, LLC

Practice address

2750 Godwin Blvd
Suffolk, VA 23434-8151

Phone

(757) 983-2000

NPI assigned

May 10, 2007

Last updated

Apr 22, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Donna A Hertzler

Title

Administrator

Phone

(757) 983-2009

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Listed as

Sentara Obici Ambulatory Surgery LLCCCN 49C0001050

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

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

• Sentara Hospitals

  dba Sentara Leigh Hospital

  • General Acute Care Hospital
  • Norfolk, VA
  • NPI 1811957681

  Member Of

  NPD member

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.

• Paul Bruce Mitchell Jr., MD

  • Neurological Surgery Physician
  • Norfolk, VA
  • NPI 1053354118
  Medicare reassignment NPD
• Jeremy Walters, DPM

  • Orthopaedic Foot and Ankle Surgery Physician
  • Suffolk, VA
  • NPI 1831450436
  Medicare reassignment NPD
• Catherine Marie Rapp, M.D.

  • Orthopaedic Surgery Physician
  • Fall River, MA
  • NPI 1285892950

  VA

  Medicare reassignment NPD
• Thomas Lee Sutton, DPT, PT, CSCS,HFI

  • Sports Physical Therapist
  • Frederick, MD
  • NPI 1508912791
  NPD
• Bryan Alan Fox, M.D.

  • Orthopaedic Surgery Physician
  • Suffolk, VA
  • NPI 1437162815
  NPD (past)

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208822400000",
    "number": "1811101439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2750 GODWIN BLVD.",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234348151",
            "telephone_number": "757-983-2000",
            "fax_number": "757-983-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2750 GODWIN BLVD",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234348151",
            "telephone_number": "757-983-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENTARA OBICI AMBULATORY SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2008-04-22",
        "status": "A",
        "authorized_official_last_name": "HERTZLER",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "757-983-2009"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1811101439",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sentara Medical Group
• Sentara Medical Group (Sentara Occupational Medicine)
• Sentara Medical Group (Sentara Surgery Specialists)
• Sentara Medical Group (Sentara Specialists)
• Sentara Medical Group (Sentara Vascular Specialists)
• Sentara Obici Surgery Ctr - Navy Resource Sharing
• Maureen C Serem, M.D.
• Serenity Medical
• Serenity TMS & Wellness PLLC (Divine Serenity Psychiatry & Wellness)
• Maribelle Serrano

• Ambulatory Surgical Clinic/Center in Suffolk, VA
• Providers in Suffolk, VA by specialty
• Ambulatory Surgical Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.