NPIMap

Organization Active NPI

Centra Medical Group, LLC

Doing business as Centra Medical Group Brookneal

  • Rural Health Clinic/Center
  • Brookneal, VA
National Provider Identifier
1861288656
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CENTRA MEDICAL GROUP, LLC
Doing business as
Centra Medical Group Brookneal
Practice address
104 Carolina Ave
Brookneal, VA 24528-2643
Phone
(434) 376-2325
NPI assigned
Apr 17, 2025
Last updated
Apr 17, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
CENTRA MEDICAL GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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

Authorized official

Name
Sonya R Turner
Title
Sr. Director Revenue Cycle
Phone
(434) 200-6942

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

104 Carolina Ave
Brookneal, VA 24528-2643

Mailing address

PO Box 749379
Atlanta, GA 30374-9379

Other names 1

  • Centra Medical Group Brookneal Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

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
O20250729000730 VA Part A Provider - Rural Health Clinic 4789606088 Practice locations: Brookneal, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861288656. Details of each certification follow.

Rural health clinic certification: CCN 493880

Legal name
CENTRA MEDICAL GROUP LLC
Doing business as
CENTRA MEDICAL GROUP BROOKNEAL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 20, 2025
Last certification
Nov 20, 2025
Ownership / control type
2B
Organization structure
LLCNon-profit
Enrollment address
104 Carolina Ave
Brookneal, VA 24528-2643

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 37

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 37

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D0233092Centra Medical Group Brookneal104 Carolina Avenue, Brookneal, VA 24528Provider-performed microscopyAug 31, 2026

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 20

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 20

Member of 1

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

Ownership & related parties

All disclosed owners & managing parties 21

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

NameRoleSinceShare
John Fees Individual Corporate Officer Jun 9, 2025
Robert Tonkinson Individual Corporate OfficerCfo Oct 1, 2024
Alison Morrison-Shetlar Individual Corporate Officer Jun 9, 2025
Gloria Witt Individual Corporate Officer Jun 9, 2025
Pamela S Bradford Individual Corporate Officer Jun 9, 2025
Todd Irby Individual Corporate Officer Jun 9, 2025
Peter a Caprise Individual Corporate Officer Jun 9, 2025
Cynthia D Gunnoe Individual Corporate Officer Jun 9, 2025
Kristi M Sink Individual W-2 Managing EmployeeAd; Jun 9, 2025
Gary Mignogna Individual Corporate Officer Jun 9, 2025
Vincent J Waldron Individual W-2 Managing EmployeeMD; Jun 9, 2025
Kemper Beasley Individual Corporate Officer Jun 9, 2025
Richard J Tugman Individual Corporate OfficerCeo Jun 9, 2025
Bonnie Svrcek Individual Corporate Officer Jun 9, 2025
Sonya Turner Individual W-2 Managing EmployeeSr. Director Revenue Cycle Jun 9, 2025
Centra Health, Inc Organization, Lynchburg, VA Medical provider/supplier 5% Or Greater Direct Ownership Interest Oct 18, 2005 100%
Clinton S Beverly Individual Corporate Officer Jun 9, 2025
Robert V Boos Individual Corporate OfficerVP Revenue Cycle Jun 9, 2025
Amy Gallagher Individual Corporate Officer Jun 9, 2025
Thomas Nygaard Individual Corporate Officer Jun 9, 2025
Geeta Rakheram Individual Corporate Officer Jun 9, 2025

Owners & managing parties with NPI records 10

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1744848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744848000000",
    "number": "1861288656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 749379",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303749379"
        },
        {
            "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 MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTRA MEDICAL GROUP, LLC",
        "enumeration_date": "2025-04-17",
        "last_updated": "2025-04-17",
        "certification_date": "2025-04-17",
        "status": "A",
        "authorized_official_last_name": "TURNER",
        "authorized_official_first_name": "SONYA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "SR. DIRECTOR REVENUE CYCLE",
        "authorized_official_telephone_number": "434-200-6942"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Centra Medical Group Brookneal",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brookneal, VA

Sources for this page

Verify at the official NPI Registry.