Sentara Albemarle Regional Medical Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

AS0053 Issued in NC

Legal business name

SENTARA ALBEMARLE REGIONAL MEDICAL CENTER, LLC

Doing business as

Sentara Kitty Hawk Ambulatory Surgery Center

Practice address

5200 N Croatan Hwy
Kitty Hawk, NC 27949-3990

Phone

(252) 255-6020

NPI assigned

Jun 19, 2014

Last updated

Nov 27, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

SENTARA HOSPITALSAs reported in NPPES

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

Authorized official

Name

Mr. Robert A Broermann

Title

Sr VP/Cfo

Phone

(757) 455-7020

Specialties & licenses 1

Addresses

Other names 1

• Sentara Kitty Hawk Ambulatory Surgery Center Doing business as

Electronic endpoints 1

Part of

Sentara Hospitals Dba LGRP

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

{
    "created_epoch": "1403136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1922412790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 N CROATAN HWY",
            "city": "KITTY HAWK",
            "state": "NC",
            "postal_code": "279493990",
            "telephone_number": "252-255-6020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5200 N CROATAN HWY",
            "city": "KITTY HAWK",
            "state": "NC",
            "postal_code": "279493990",
            "telephone_number": "252-255-6020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENTARA ALBEMARLE REGIONAL MEDICAL CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SENTARA HOSPITALS",
        "enumeration_date": "2014-06-19",
        "last_updated": "2023-11-27",
        "certification_date": "2020-04-06",
        "status": "A",
        "authorized_official_last_name": "BROERMANN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "SR VP/CFO",
        "authorized_official_telephone_number": "757-455-7020",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NC",
            "license": "AS0053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://urldefense.proofpoint.com/v2/url?u=https-3A__cobiusconnect.cobius.com-3A8291_Gateway_Documen",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Sentara Kitty Hawk Ambulatory Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sentara Kitty Hawk Ambulatory Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Eric Robisch, PA-C
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• Sentara Albemarle Regional Medical Center LLC (Sentara Albemarle Medical Center)
• Sentara Albemarle Regional Medical Center, LLC (Sentara Kitty Hawk)
• Sentara Albemarle Regional Medical Center, LLC (Sentara Kitty Hawk)
• Sentara Albemarle Regional Medical Center, LLC (Sentara Kitty Hawk Advanced Imaging Center)
• Sentara Medical Group (Sentara Cardiology Specialists)
• Rebecca Ann Shealey, M.S. CCC-SLP
• Bruce G Shepard, PHD
• Zoe C Sherman, PA-C, MHS

• Ambulatory Surgical Clinic/Center in Kitty Hawk, NC
• Providers in Kitty Hawk, NC by specialty
• Ambulatory Surgical Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.