SENTARA MEDICAL GROUP (NPI# 1093075319) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093075319 |
| Entity Type | Organization |
| Organization Name | SENTARA MEDICAL GROUP |
| Other Organization Name | POTOMAC VASCULAR SURGERY |
| Practice Address |
2296 Opitz Blvd Ste 260a Woodbridge VA 22191-3300 |
| Practice Telephone | 5406578180 |
| Mailing Telephone | 5406578180 |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2012-05-21 |
| Authorized Official Name | MRS. CINDY A TAYLOR (MANAGER) |
| Authorized Official Telephone | 7572523344 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | MEDICARE GROUP NUMBER | C02033 | 01 |
| Other Name | Type Code |
|---|---|
| Potomac Vascular Surgery | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811533375 | Sentara Medical Group | Internal Medicine | 1101 First Colonial Rd Ste 300, Virginia Beach, VA 23454-2409 | 2019-11-20 |
| 1285115998 | Sentara Medical Group | Surgery | 397 Little Neck Rd Ste 110, Virginia Beach, VA 23452-5774 | 2018-08-22 |
| 1336627207 | Sentara Medical Group | Emergency Medicine | 844 Kempsville Rd Ste 103, Norfolk, VA 23502 | 2018-08-02 |
| 1073010369 | Sentara Medical Group | Preventive Medicine | 2760 Godwin Blvd Ste 101, Suffolk, VA 23434-8501 | 2018-04-12 |
| 1376043489 | Sentara Medical Group | Internal Medicine | 301 Riverview Ave Ste 670, Norfolk, VA 23510-1065 | 2018-02-15 |
| 1629586417 | Sentara Medical Group | Surgery | 1051 Loftis Blvd Ste 210, Newport News, VA 23606-3069 | 2018-01-16 |
| 1558879346 | Sentara Medical Group | Family Medicine | 301 Riverview Ave Ste 930, Norfolk, VA 23510-1068 | 2018-01-16 |
| 1942724620 | Sentara Medical Group | Surgery | 500 Sentara Cir Ste 100, Williamsburg, VA 23188-5727 | 2017-08-03 |
| 1265954747 | Sentara Medical Group | Internal Medicine | 1933 Edwin Dr Ste 208a, Chesapeake, VA 23322-6531 | 2017-07-17 |
| 1487195111 | Sentara Medical Group | Clinical Medical Laboratory | 1933 Edwin Dr, Suite 104, Chesapeake, VA 23322-6531 | 2017-03-14 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | Sentara Medical Group | 835 Glenrock Road, Norfolk, Virginia 23502 |
| System for Award Management (SAM) Entities | SENTARA MEDICAL GROUP | 863 Glenrock Rd Ste 208, Norfolk, VA 23502-3701 |
| North Carolina Corporations | Sentara medical Group | 160 Mine Lake Ct Ste 200, Raleigh, NC 27615 |
| Street Address |
2296 OPITZ BLVD STE 260A |
| City | WOODBRIDGE |
| State | VA |
| Zip Code | 22191-3300 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447254263 | Robert A Sikora Jr. | Allergy & Immunology | 2296 Opitz Blvd, Ste 401, Woodbridge, VA 22191-3347 | 2005-06-09 |
| 1730536921 | Janet O'connor | General Practice | 2296 Opitz Blvd, #255, Woodbridge, VA 22191-3300 | 2016-05-18 |
| 1134545775 | Sentara Medical Group | Psychiatry & Neurology | 2296 Opitz Blvd, Ste 290, Woodbridge, VA 22191-3300 | 2014-03-06 |
| 1740561471 | Andrew V. Kriegel, Md, LLC | Plastic Surgery | 2296 Opitz Blvd, Suite 210, Woodbridge, VA 22191-3300 | 2011-09-08 |
| 1063734820 | Morteza S. Mousavi, M.d., P.C. | Specialist | 2296 Opitz Blvd, Suite 340, Woodbridge, VA 22191-3300 | 2010-02-22 |
| 1588896625 | Jennifer Leigh Folks | Nurse Practitioner | 2296 Opitz Blvd, #440, Woodbridge, VA 22191-3300 | 2009-08-21 |
| 1003051897 | Potomac Pediatrics, P.C. | Clinic/Center | 2296 Opitz Blvd, Suite 510, Woodbridge, VA 22191-3300 | 2008-12-08 |
| 1861657488 | Nilay Gandhi | Urology | 2296 Opitz Blvd, Suite 350, Woodbridge, VA 22191-3300 | 2008-07-23 |
| 1528229622 | Steven Nakao | Surgery | 2296 Opitz Blvd, Ste 260, Woodbridge, VA 22191-3300 | 2008-06-20 |
| 1194982819 | Potomac Ophthalmology PC | Ophthalmology | 2296 Opitz Blvd, Suite 410, Woodbridge, VA 22191-3300 | 2008-05-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861021131 | Bailey Orthodontics Pllc | Dentist | 16446 Navigation Drive, Woodbridge, VA 22191 | 2020-04-07 |
| 1417589326 | Meseret Abate | Registered Nurse | 15608 William Bayliss Ct, Woodbridge, VA 22191 | 2020-02-08 |
| 1992279327 | Velocity Urgent Care, LLC | Clinic/Center | 16422 Navigation Dr, Woodbridge, VA 22191 | 2019-01-18 |
| 1821577263 | Maame Gyasiwah Banahene | Registered Nurse | 1812 Featherstone Rd, Woodbridge, VA 22191 | 2018-08-07 |
| 1235617507 | Yaw P. Baidoo | Nutritionist | 14960 Potomac Heights Pl Apt 503, Woodbridge, VA 22191 | 2018-07-30 |
| 1477048452 | Anahita Abazari | Optometrist | 14901 Potomac Town Pl, Suite 120, Woodbridge, VA 22191 | 2018-06-22 |
| 1619490661 | Misti S Gray | Nurse Practitioner | 2296 Optiz Blvd, Suite 440, About Women Ob/gyn, Woodbridge, VA 22191 | 2017-07-21 |
| 1568991974 | Patrice Whilby | Behavior Technician | 2264 York Drive Apt 302, Woodbridge, VA 22191 | 2017-06-08 |
| 1508395245 | Maria Theresa Lee | Registered Nurse | 2028b Opitz Blvd # 22191, Woodbridge, VA 22191 | 2017-06-07 |
| 1861943763 | A1 Home Care, LLC | Home Health | 13928 Jefferson Davis Hwy, Ste # C, Woodbridge, VA 22191 | 2016-10-17 |
| Find all providers in zip 22191 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437247756 | Mauricio Dionisio Bas Jr. | Surgery | 1970 Opitz Blvd, Woodbridge, VA 22191-3304 | 2006-10-11 |
| 1245577550 | Sentara Medical Group | Surgery | 2300 Opitz Blvd, Heart and Vascular Center, Woodbridge, VA 22191-3345 | 2013-01-07 |
| 1912028531 | Mauricio D. Bas, Jr., M.d., P.C. | Surgery | 1970 Opitz Blvd, Woodbridge, VA 22191-3304 | 2007-04-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124670930 | Usa Vein Clinics of Chantilly LLC | Surgery | 3914 Centreville Rd Ste 125, Chantilly, VA 20151-3289 | 2019-07-11 |
| 1285115998 | Sentara Medical Group | Surgery | 397 Little Neck Rd Ste 110, Virginia Beach, VA 23452-5774 | 2018-08-22 |
| 1629586417 | Sentara Medical Group | Surgery | 1051 Loftis Blvd Ste 210, Newport News, VA 23606-3069 | 2018-01-16 |
| 1942724620 | Sentara Medical Group | Surgery | 500 Sentara Cir Ste 100, Williamsburg, VA 23188-5727 | 2017-08-03 |
| 1972980761 | Carlos Jose Torres-medina | Surgery | 500 J Clyde Morris Blvd # 603, Newport News, VA 23601-1929 | 2015-04-30 |
| 1306280128 | Justin Marc Milligan | Surgery | 397 Little Neck Rd Ste 120, Virginia Beach, VA 23452-5774 | 2013-04-23 |
| 1578817938 | Clinch Valley Vascular Surgical Assoc., Pllc | Surgery | 6719 Gov. G.c. Peery Highway, Suite 2600, Richlands, VA 24641 | 2012-11-06 |
| 1346503463 | Mid Atlantic Vascular Holding, LLC | Surgery | 1415 Eastridge Rd, Richmond, VA 23229-5501 | 2012-06-22 |
| 1265791297 | Vascular Surgery Group | Surgery | 850 Chistensen Court, Great Falls, VA 22066 | 2012-05-11 |
| 1902122922 | Hao Duy Pham | Surgery | 6719 Governor Gc Peery Hwy Ste 2600, Richlands, VA 24641 | 2010-04-15 |
| Find all providers with the same taxonomy | ||||
| City | WOODBRIDGE |
| Zip Code | 22191 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.