NPIMap

Centra Medical Group, LLC

Organization Active NPI Rural Health Clinic/Center · Brookneal, VA

NPI 1861288656 · NPPES record last updated Apr 17, 2025

Key facts

NPI
1861288656
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
CENTRA MEDICAL GROUP, LLC
Practice address
104 Carolina Ave
Brookneal, VA 24528-2643
Phone
(434) 376-2325
NPI assigned
Apr 17, 2025
Organization subpart
Yes
Parent organization (as reported)
CENTRA MEDICAL GROUP, LLC

Authorized official

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

Owners & managing parties with NPI records 10

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

Other NPIs on the same Medicare enrollment 37

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

View all 37

Other NPIs with the same Medicare PAC ID 2

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

Corporate family (same tax ID) 20

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.

Facilities with the same owner 4

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

Practitioners 710

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 710

Laboratory certificates & supplier records

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

CLIA laboratory certificates

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in VA

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
LLC · Non-profit
Enrollment address
104 Carolina Ave
Brookneal, VA 24528-2643

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 Officer
Cfo		 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 Employee
Ad;		 Jun 9, 2025
Gary Mignogna
Individual 		Corporate Officer Jun 9, 2025
Vincent J Waldron
Individual 		W-2 Managing Employee
MD;		 Jun 9, 2025
Kemper Beasley
Individual 		Corporate Officer Jun 9, 2025
Richard J Tugman
Individual 		Corporate Officer
Ceo		 Jun 9, 2025
Bonnie Svrcek
Individual 		Corporate Officer Jun 9, 2025
Sonya Turner
Individual 		W-2 Managing Employee
Sr. 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 Officer
VP 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

Medicare enrollment records

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

National Provider Directory

Tax ID family
Centra Health Professional Services (106 organizations share this tax ID)
Part of
Centra Health Professional Services

Specialties & licenses

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

Addresses

Primary practice location

104 Carolina Ave
Brookneal, VA 24528-2643

Mailing address

PO Box 749379
Atlanta, GA 30374-9379

Other names

  • Centra Medical Group Brookneal Doing business as

Other providers in Brookneal, VA

All providers in Brookneal, VA · Rural Health Clinic/Center in Virginia

Sources for this page

Verify at the official NPI Registry.