Yes
VA | | 1811957681,1821403791 |
NC | | 1811957681,1821403791 |
RRC490046-01 | Child | RRC | SENTARA LEIGH HOSPITAL | Sentara Endocrinology Specialists - - Kempsville | 850 Kempsville Road | Norfolk | VA | Active |
RRC490046-02 | Child | RRC | SENTARA LEIGH HOSPITAL | Sentara Pulmonary, Critical Care & Sleep Specialists - - Kempsville | 844 Kempsville Road | Norfolk | VA | Active |
RRC490046-03 | Child | RRC | SENTARA LEIGH HOSPITAL | Sentara Hospitals DBA Sentara Cancer Center - - PET/CT Suite 100 | 6251 E. Virginia Beach Blvd | Norfolk | VA | Active |
RRC490046-04 | Child | RRC | SENTARA LEIGH HOSPITAL | Ambulatory Surgery Center - (ASC) | 838 Kempsville Road | Norfolk | VA | Active |
RRC490046-05 | Child | RRC | SENTARA LEIGH HOSPITAL | Noninvasive Echo - 2 | 844 Kempsville Road | Norfolk | VA | Active |
RRC490046-06 | Child | RRC | SENTARA LEIGH HOSPITAL | Cardiology PVL - Cardiology | 844 Kempsville Road | Norfolk | VA | Active |
RRC490046-07 | Child | RRC | SENTARA LEIGH HOSPITAL | Nuclear Medicine - Cardiology | 844 Kempsville Road | Norfolk | VA | Active |
RRC490046-08 | Child | RRC | SENTARA LEIGH HOSPITAL | Cardiology Specialists Leigh - Cardiology | 844 Kempsville Road | Norfolk | VA | Active |
RRC490046-09 | Child | RRC | SENTARA LEIGH HOSPITAL | Walk-in Care Kempsville - Urgent Care | 850 Kempsville Road | Norfolk | VA | Active |
RRC490046-10 | Child | RRC | SENTARA LEIGH HOSPITAL | Cardiology Specialists Chesapeake - Cardiology | 713 Volvo Parkway | Chesapeake | VA | Active |
RRC490046-11 | Child | RRC | SENTARA LEIGH HOSPITAL | Internal Medicine Kempsville - Urgent Care | 850 Kempsville Road | Norfolk | VA | Active |
Contacts | Authorizing Official | Update | Change Request | Inman, Joanne Marie
President
Sentara Leigh Hospital
7572618300 | O'Brien, Tim
Vice President
Sentara Leigh Hospital
7572618610 | 3/18/2025 12:46 PM |
Details | State | Update | | Approved | Active | 1/1/2025 12:01 AM |
Contacts | Signed By | Insert | New Registration | | Inman, Joanne Marie
President
Sentara Leigh Hospital
7572618300 | 10/31/2024 8:51 AM |
Details | 340B ID | Update | New Registration | | RRC490046-08 | 10/31/2024 8:51 AM |
Details | Entity Subname | Update | New Registration | Cardiology Specialists Leigh | Cardiology Specialists Leigh - Cardiology | 10/31/2024 8:51 AM |
Dates | Participating Approval Date | Update | New Registration | | 10/31/2024 8:51:00 AM | 10/31/2024 8:51 AM |
Details | State | Update | New Registration | Pending | Approved | 10/31/2024 8:51 AM |
Dates | Signed By Date | Update | New Registration | | 10/29/2024 2:47:27 PM | 10/31/2024 8:51 AM |
Dates | Start Date | Update | New Registration | | 1/1/2025 12:00:00 AM | 10/31/2024 8:51 AM |
Addresses | Main Address | Insert | New Registration | |
844 Kempsville Road
Suite 204
Norfolk, VA 23502 | 10/8/2024 12:12 PM |
Addresses | Billing Address | Insert | New Registration | | Sentara Leigh Hospital
1300 Sentara Park
Virginia Beach, VA 23464 | 10/8/2024 12:12 PM |
Medicaid Billing | NPI: Number | Insert | New Registration | | 1811957681 | 10/8/2024 12:12 PM |
Medicaid Billing | NPI: State | Insert | New Registration | | VA | 10/8/2024 12:12 PM |
Medicaid Billing | NPI: Number | Insert | New Registration | | 1821403791 | 10/8/2024 12:12 PM |
Medicaid Billing | NPI: State | Insert | New Registration | | VA | 10/8/2024 12:12 PM |
Medicaid Billing | NPI: Number | Insert | New Registration | | 1811957681 | 10/8/2024 12:12 PM |
Medicaid Billing | NPI: State | Insert | New Registration | | NC | 10/8/2024 12:12 PM |
Medicaid Billing | NPI: Number | Insert | New Registration | | 1821403791 | 10/8/2024 12:12 PM |
Medicaid Billing | NPI: State | Insert | New Registration | | NC | 10/8/2024 12:12 PM |
Contacts | Primary Contact | Insert | New Registration | | Lazar, Nicole
Pharmacy Manager - Primary Contact
Sentara Leigh Hospital
7572618037 | 10/8/2024 12:12 PM |
Contacts | Authorizing Official | Insert | New Registration | | Inman, Joanne Marie
President
Sentara Leigh Hospital
7572618300 | 10/8/2024 12:12 PM |
Details | Assistance Received From Date | Insert | New Registration | | | 10/8/2024 12:12 PM |
Details | Assistance Received To Date | Insert | New Registration | | | 10/8/2024 12:12 PM |
Details | Last Recertification Date | Insert | New Registration | | | 10/8/2024 12:12 PM |
Details | Grant Number | Insert | New Registration | | | 10/8/2024 12:12 PM |
Details | 340B ID | Insert | New Registration | | | 10/8/2024 12:12 PM |
Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 10/8/2024 12:12 PM |
Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 10/8/2024 12:12 PM |
Details | Medicare Provider Number | Insert | New Registration | | 490046 | 10/8/2024 12:12 PM |
Details | Entity Name | Insert | New Registration | | SENTARA LEIGH HOSPITAL | 10/8/2024 12:12 PM |
Details | NOFO Number | Insert | New Registration | | | 10/8/2024 12:12 PM |
Details | Program Code | Insert | New Registration | | RRC | 10/8/2024 12:12 PM |
Details | Entity Subname | Insert | New Registration | | Cardiology Specialists Leigh | 10/8/2024 12:12 PM |
Dates | Participating Approval Date | Insert | New Registration | | | 10/8/2024 12:12 PM |
Details | State | Insert | New Registration | | Pending | 10/8/2024 12:12 PM |
Dates | Registration Date | Insert | New Registration | | 10/8/2024 12:12:13 PM | 10/8/2024 12:12 PM |
Dates | Signed By Date | Insert | New Registration | | | 10/8/2024 12:12 PM |
Dates | Start Date | Insert | New Registration | | | 10/8/2024 12:12 PM |
Terminations | Termination Comments | Insert | New Registration | | | 10/8/2024 12:12 PM |
Terminations | Termination Date | Insert | New Registration | | | 10/8/2024 12:12 PM |
Terminations | Termination Effective Date | Insert | New Registration | | | 10/8/2024 12:12 PM |
Terminations | Termination Reason | Insert | New Registration | | | 10/8/2024 12:12 PM |