NPIMap

Organization Active NPI

Dominion Health Medical Associates LTD

  • Non-Surgical Family Planning Clinic/Center
  • South Boston, VA
National Provider Identifier
1992244172
Registry record updated Feb 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Surgical Family Planning Clinic/CenterTaxonomy code 261QF0050X
Legal business name
DOMINION HEALTH MEDICAL ASSOCIATES LTD
Practice address
2206 Wilborn Ave
South Boston, VA 24592
Phone
(434) 517-8627
Fax
(434) 517-8080
NPI assigned
Feb 21, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2017

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

Authorized official

Name
Cecil Hazelwood
Title
Manager
Phone
(434) 517-3515

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Surgical Family Planning Clinic/Center 261QF0050X Primary

Addresses

Primary practice location

2206 Wilborn Ave
South Boston, VA 24592

Mailing address

P.O. Box 860
South Boston, VA 24592
Phone (434) 517-3547

Other names 1

  • Sentara Obstetrics & Gynecology Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041206000840 VA Part B Supplier - Clinic/Group Practice 1254311558 Receives reassigned benefits from 91 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: South Boston, VA

Rural health clinic certification: CCN 493458

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SENTARA OBSTETRICS AND GYNECOLOGY
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 31, 2021
Last certification
Mar 31, 2021
Ownership / control type
1B
Facility address
2206 Wilborn Avenue
South Boston, VA 24592
Related CCNs
490013

Other NPIs on the same Medicare enrollment 17

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

View all 17

National Provider Directory

National Provider Directory

Locations

2206 Wilborn Ave
South Boston, VA 24592
Phone (434) 517-8075

Practitioners & affiliated clinicians

Practitioners 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1487635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488153600000",
    "number": "1992244172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 860",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "24592",
            "telephone_number": "434-517-3547",
            "fax_number": "434-517-3887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2206 WILBORN AVE",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "24592",
            "telephone_number": "434-517-8627",
            "fax_number": "434-517-8080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOMINION HEALTH MEDICAL ASSOCIATES LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-21",
        "last_updated": "2017-02-27",
        "status": "A",
        "authorized_official_last_name": "HAZELWOOD",
        "authorized_official_first_name": "CECIL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "434-517-3515"
    },
    "taxonomies": [
        {
            "code": "261QF0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Family Planning, Non-Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sentara Obstetrics & Gynecology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Boston, VA

Sources for this page

Verify at the official NPI Registry.