EASTLAKE PRIMARY CARE PC
NPI 1043002934
Family Medicine in Moneta, VA
About Eastlake Primary Care Pc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
EASTLAKE PRIMARY CARE PC (NPI 1043002934) is a healthcare organization registered as a family medicine in Moneta, Virginia and active in the NPI registry since May 2025. The organization holds a CLIA Waiver certificate valid through August 27, 2027 and lists Holly Hullett Roy, Ceo, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Eastlake Primary Care Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Eastlake Primary Care PC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 49D2329404
Eastlake Primary Care PC · Moneta, VAFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Eastlake Primary Care PC's NPI number?
The NPI number for Eastlake Primary Care PC is 1043002934. It was assigned to this organization in the NPPES registry on May 19, 2025.
Where is Eastlake Primary Care PC located?
Eastlake Primary Care PC is located at 14807 Moneta Rd Ste J, Moneta, VA 24121. The listed phone number is (540) 703-2682.
What is Eastlake Primary Care PC's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Eastlake Primary Care PC enrolled in Medicare?
Yes. Eastlake Primary Care PC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Eastlake Primary Care PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Eastlake Primary Care PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Eastlake Primary Care PC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 49D2329404) is associated with this NPI, valid through August 27, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Eastlake Primary Care PC was last updated on February 25, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Eastlake Primary Care Pc · NPI 1043002934
Family Medicine organization in Moneta, Virginia. Organization record, active in the CMS NPPES registry since May 19, 2025.
## Identity
- **NPI:** 1043002934 (Entity type: Organization)
- **Enumerated:** May 19, 2025
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Holly Roy, CEO
## Practice location
- **Address:** 14807 MONETA RD STE J, Moneta, VA 24121-6449
- **Phone:** (540) 703-2682
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** February 25, 2026
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1043002934) · Data from the CMS NPPES public registry.