NPIMap

Organization Active NPI

Centra Medical Group Southside, LLC

  • Family Medicine Physician
  • Farmville, VA
National Provider Identifier
1841479565
Registry record updated Aug 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CENTRA MEDICAL GROUP SOUTHSIDE, LLC
Practice address
800 Oak St
Farmville, VA 23901-1199
Phone
(434) 200-3656
NPI assigned
Oct 30, 2007
Last updated
Aug 7, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2014

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

Authorized official

Name
William Bass
Title
Cfo
Phone
(434) 392-8811

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary
Internal Medicine Physician 207R00000X NU
Endocrinology, Diabetes & Metabolism Physician 207RE0101X NU
Neurology Physician 2084N0400X NU
Surgery Physician 208600000X NU

Addresses

Primary practice location

800 Oak St
Farmville, VA 23901-1199

Mailing address

2010 Atherholt Rd
Lynchburg, VA 24501-1106

Other identifiers 11

IdentifierTypeStateIssuer
61459600OtherVABLACK LUNG/FECA (STE 3105)
61459601OtherVABLACK LUNG/FECA (312 KING ST)
61459602OtherVABLACK LUNG/FECA (412 NAMOZINE STR)
345608OtherVAANTHEM BCBS (312 KING STREET)
61459603OtherVABLACK LUNG/FECA (1705 3RD ST)
345606OtherVAANTHEM BCBS (412 NAMOZINE STREET)
61459604OtherVABLACK LUNG/FECA (1418 6TH ST)
9978134OtherVAAETNA
345307OtherVAANTHEM, BCBS (1418 6TH STREET)
1841479565MedicaidVA
345604OtherVAANTHEM BCBS (800 OAK STREET)

National Provider Directory

National Provider Directory

Member of 1

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

Locations

412 Namozine St
Burkeville, VA 23922
Phone (434) 767-5511

412 Namozine St
#385
Burkeville, VA 23922
Phone (434) 767-5511

312 King St
#360
Keysville, VA 23947
Phone (434) 736-8801

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 80

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.

View all 80

NPI Registry JSON

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

{
    "created_epoch": "1193702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407369600000",
    "number": "1841479565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2010 ATHERHOLT RD",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245011106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 OAK ST",
            "city": "FARMVILLE",
            "state": "VA",
            "postal_code": "239011199",
            "telephone_number": "434-200-3656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRA MEDICAL GROUP SOUTHSIDE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-30",
        "last_updated": "2014-08-07",
        "status": "A",
        "authorized_official_last_name": "BASS",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "434-392-8811"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLACK LUNG/FECA (STE 3105)",
            "identifier": "61459600",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLACK LUNG/FECA (312 KING ST)",
            "identifier": "61459601",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLACK LUNG/FECA (412 NAMOZINE STR)",
            "identifier": "61459602",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS (312 KING STREET)",
            "identifier": "345608",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLACK LUNG/FECA (1705 3RD ST)",
            "identifier": "61459603",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS (412 NAMOZINE STREET)",
            "identifier": "345606",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLACK LUNG/FECA (1418 6TH ST)",
            "identifier": "61459604",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "9978134",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM, BCBS (1418 6TH STREET)",
            "identifier": "345307",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1841479565",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS (800 OAK STREET)",
            "identifier": "345604",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmville, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.