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EASTLAKE PRIMARY CARE PC
NPI 1043002934
Family Medicine in Moneta, VA

Active since May 19, 2025CLIA 49D2329404 · Waiver
14807 MONETA RD STE J, MONETA, VA 24121(540) 703-2682 Get Directions Write a Review

NPPES record last updated: February 25, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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

NPI1043002934
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameEASTLAKE PRIMARY CARE PC
Location Address14807 MONETA RD STE JMoneta, VA 24121-6449
Mailing Address14807 Moneta Rd Ste JMoneta, VA 24121-6449 · (540) 703-2682 · Fax (540) 698-1030
Phone(540) 703-2682
Organization SubpartNo
Authorized OfficialHolly Hullett RoyCeo · (540) 703-2682
Enumeration DateMay 19, 2025
Last NPPES UpdateFebruary 25, 2026
NPPES CertifiedFebruary 25, 2026
✔ NPI 1043002934 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
14807 MONETA RD STE J, Moneta, VA 24121
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

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, VA
Active · expires Aug 27, 2027
CLIA Number49D2329404
Laboratory TypeOutpatient Primary Care
Certificate Effective DateAugust 28, 2025
Certificate Expiration DateAugust 27, 2027
Laboratory DirectorHolly H. Roy
Laboratory Phone(540) 580-1624
Laboratory LocationEastlake Primary Care PC14807 Moneta Rd, Suite J, Moneta, VA 24121
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. HOLLY HULLETT ROY PA-C
Physician Assistant
14807 MONETA RD STE J
MONETA, VA 24121
Bedford County (540) 703-2682

Frequently 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.

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 5 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.