Yes
| VA | | 1811957681 |
| NC | | 1811957681 |
Sentara Leigh Hospital
830 Kempsville Rd
Norfolk, VA 23502
| 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 |
| Addresses | Shipping Address | Insert | Group Change Request | | Sentara Leigh Hospital
830 Kempsville Rd
Norfolk, VA 23502 | 10/10/2024 9:02 AM |
| Addresses | Billing Address | Update | Recertification | Sentara Leigh Hospital
6015 Poplar Hall Drive
Norfolk, VA 23502 | Sentara Leigh Hospital
1300 Sentara Park
Virginia Beach, VA 23464 | 9/4/2024 11:13 AM |
| Details | Last Recertification Date | Update | Recertification | 8/28/2023 11:01:05 AM | 9/4/2024 11:13:18 AM | 9/4/2024 11:13 AM |
| Medicaid Billing | Medicaid: Number | Delete | Change Request | 1811957681 (VA) | | 1/9/2024 3:09 PM |
| Medicaid Billing | Medicaid: Number | Delete | Change Request | 1811957681 (NC) | | 1/9/2024 3:09 PM |
| Details | Last Recertification Date | Update | Recertification | 8/24/2022 5:03:28 PM | 8/28/2023 11:01:05 AM | 8/28/2023 11:01 AM |
| Contacts | Authorizing Official | Update | Profile Change Request | Inman, Joanne Inman Marie
President
Sentara Leigh Hospital
7572618300 | Inman, Joanne Marie
President
Sentara Leigh Hospital
7572618300 | 5/5/2023 12:48 PM |
| Contacts | Signed By | Update | Profile Change Request | Inman, Joanne Inman Marie
President
Sentara Leigh Hospital
7572618300 | Inman, Joanne Marie
President
Sentara Leigh Hospital
7572618300 | 5/5/2023 12:48 PM |
| Details | Last Recertification Date | Update | Recertification | | 8/24/2022 5:03:28 PM | 8/24/2022 5:03 PM |
| Details | State | Update | | Approved | Active | 7/1/2022 12:01 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 6/13/2022 2:00 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 1811957681 | 6/13/2022 2:00 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | VA | 6/13/2022 2:00 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 6/13/2022 2:00 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 1811957681 | 6/13/2022 2:00 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | NC | 6/13/2022 2:00 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1811957681 | 6/13/2022 2:00 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | VA | 6/13/2022 2:00 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1811957681 | 6/13/2022 2:00 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | NC | 6/13/2022 2:00 PM |
| Contacts | Signed By | Insert | New Registration | | Inman, Joanne Inman Marie
President
Sentara Leigh Hospital
7572618300 | 5/2/2022 2:31 PM |
| Details | 340B ID | Update | New Registration | | RRC490046-01 | 5/2/2022 2:31 PM |
| Details | Entity Subname | Update | New Registration | Sentara Endocrinology Specialists | Sentara Endocrinology Specialists - - Kempsville | 5/2/2022 2:31 PM |
| Dates | Participating Approval Date | Update | New Registration | | 5/2/2022 2:31:47 PM | 5/2/2022 2:31 PM |
| Details | State | Update | New Registration | Pending | Approved | 5/2/2022 2:31 PM |
| Dates | Signed By Date | Update | New Registration | | 4/14/2022 4:04:31 PM | 5/2/2022 2:31 PM |
| Dates | Start Date | Update | New Registration | | 7/1/2022 12:00:00 AM | 5/2/2022 2:31 PM |
| Addresses | Main Address | Insert | New Registration | |
850 Kempsville Road
Suite 100E
Norfolk, VA 23502 | 4/7/2022 10:11 AM |
| Addresses | Billing Address | Insert | New Registration | | Sentara Leigh Hospital
6015 Poplar Hall Drive
Norfolk, VA 23502 | 4/7/2022 10:11 AM |
| Contacts | Primary Contact | Insert | New Registration | | Lazar, Nicole
Pharmacy Manager - Primary Contact
Sentara Leigh Hospital
7572618037 | 4/7/2022 10:11 AM |
| Contacts | Authorizing Official | Insert | New Registration | | Inman, Joanne Inman Marie
President
Sentara Leigh Hospital
7572618300 | 4/7/2022 10:11 AM |
| Details | Assistance Received From Date | Insert | New Registration | | | 4/7/2022 10:11 AM |
| Details | Assistance Received To Date | Insert | New Registration | | | 4/7/2022 10:11 AM |
| Details | Last Recertification Date | Insert | New Registration | | | 4/7/2022 10:11 AM |
| Details | Grant Number | Insert | New Registration | | | 4/7/2022 10:11 AM |
| Details | 340B ID | Insert | New Registration | | | 4/7/2022 10:11 AM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 4/7/2022 10:11 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 4/7/2022 10:11 AM |
| Details | Medicare Provider Number | Insert | New Registration | | 490046 | 4/7/2022 10:11 AM |
| Details | Entity Name | Insert | New Registration | | SENTARA LEIGH HOSPITAL | 4/7/2022 10:11 AM |
| Details | NOFO Number | Insert | New Registration | | | 4/7/2022 10:11 AM |
| Details | Program Code | Insert | New Registration | | RRC | 4/7/2022 10:11 AM |
| Details | Entity Subname | Insert | New Registration | | Sentara Endocrinology Specialists | 4/7/2022 10:11 AM |
| Dates | Participating Approval Date | Insert | New Registration | | | 4/7/2022 10:11 AM |
| Details | State | Insert | New Registration | | Pending | 4/7/2022 10:11 AM |
| Dates | Registration Date | Insert | New Registration | | 4/7/2022 10:11:28 AM | 4/7/2022 10:11 AM |
| Dates | Signed By Date | Insert | New Registration | | | 4/7/2022 10:11 AM |
| Dates | Start Date | Insert | New Registration | | | 4/7/2022 10:11 AM |
| Terminations | Termination Comments | Insert | New Registration | | | 4/7/2022 10:11 AM |
| Terminations | Termination Date | Insert | New Registration | | | 4/7/2022 10:11 AM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 4/7/2022 10:11 AM |
| Terminations | Termination Reason | Insert | New Registration | | | 4/7/2022 10:11 AM |