NPIMap

Organization Active NPI

Halifax Radiological Associates, Inc.

  • Specialist
  • South Boston, VA
National Provider Identifier
1952465064
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
0101027902 Issued in VA
Legal business name
HALIFAX RADIOLOGICAL ASSOCIATES, INC.
Practice address
2204 Wilborn Ave
Radiology Department
South Boston, VA 24592-1645
Phone
(434) 517-3187
Fax
(434) 517-3686
NPI assigned
Dec 21, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Elmer San Pedro, M.D.NPI 1174532535
Title
President
Phone
(434) 517-3686

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 0101027902 VA Primary

Addresses

Primary practice location

2204 Wilborn Ave
Radiology Department
South Boston, VA 24592-1645

Mailing address

2204 Wilborn Ave
Radiology Department
South Boston, VA 24592-1645
Phone (434) 517-3187

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040511000798 VA Part B Supplier - Clinic/Group Practice 9931198280 Receives reassigned benefits from 3 practitioners
Practice locations: South Boston, VA
O20180806001426 NC Part B Supplier - Clinic/Group Practice 9931198280 Receives reassigned benefits from 2 practitioners
Practice locations: Durham, NC; Providence, NC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1952465064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2204 WILBORN AVE",
            "address_2": "RADIOLOGY DEPARTMENT",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245921645",
            "telephone_number": "434-517-3187",
            "fax_number": "434-517-3686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2204 WILBORN AVE",
            "address_2": "RADIOLOGY DEPARTMENT",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245921645",
            "telephone_number": "434-517-3187",
            "fax_number": "434-517-3686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HALIFAX RADIOLOGICAL ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "SAN PEDRO",
        "authorized_official_first_name": "ELMER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "434-517-3686",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "VA",
            "license": "0101027902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Boston, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.