NPIMap

Organization Active NPI

Chesapeake Hospital LLC

  • Rural Health Clinic/Center
  • Hartfield, VA
National Provider Identifier
1013407543
Registry record updated Sep 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CHESAPEAKE HOSPITAL LLC
Practice address
9891 General Puller Hwy
Hartfield, VA 23071-3122
Phone
(804) 776-9221
Fax
(804) 776-7537
NPI assigned
May 10, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kimberly Ralston
Title
System Director
Phone
(419) 996-5119

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

9891 General Puller Hwy
Hartfield, VA 23071-3122

Mailing address

PO Box 639991
Cincinnati, OH 45263-9991
Phone (804) 627-5573

Other names 1

  • Bon Secours Hartfield Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041027001018 VA Part B Supplier - Clinic/Group Practice 8921060427 Receives reassigned benefits from 20 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kilmarnock, VA; Lively, VA; Heathsville, VA; Hartfield, VA
O20180816002697 VA Part A Provider - Rural Health Clinic 8921060427 Practice locations: Hartfield, VA

Rural health clinic certification: CCN 493433

Legal name
CHESAPEAKE HOSPITAL LLC
Doing business as
BON SECOURS HARTFIELD MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 15, 2018
Last certification
Nov 15, 2018
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Apr 27, 1973 in VA
Enrollment address
9891 General Puller Hwy
Hartfield, VA 23071-3122
Related CCNs
491308

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 21

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jeffrey Szyperski Individual Corporate DirectorBoard Member Jan 1, 2024
Rebecca W McDonough Individual Corporate DirectorBoard Member Jan 1, 2025
Paula P Pando Individual Corporate DirectorBoard Member Jan 1, 2025
Robert Ukrop Individual Corporate DirectorBoard Member Jan 1, 2025
Wael N Haidar Individual Corporate DirectorBoard Member Jan 1, 2023
Osman Parvaiz Individual Corporate DirectorBoard Member Jan 1, 2025
Lang R Liebman Individual Corporate DirectorBoard Member Jan 1, 2022
James Carter Individual Corporate DirectorBoard Member Jan 1, 2025
Brian Yanofchick Individual Corporate DirectorBoard Member Jan 1, 2020
Bon Secours Mercy Health Inc Organization, Cincinnati, OH Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Dec 31, 2014 100%
John Starcher Individual Operational/Managerial ControlCho Admin Sep 1, 2018
Regina J Elbert Individual Corporate DirectorBoard Member Jan 1, 2022
Michael Quinones Individual Corporate DirectorBoard Member Jan 1, 2023
William Kusnierz Individual Corporate OfficerCfo Richmond MKT Sep 8, 2020
Corporate DirectorCfo Richmond MKT Sep 8, 2020
W-2 Managing EmployeeCfo Richmond MKT Sep 8, 2020
Mary Shimo Individual Corporate DirectorBoard Member Apr 22, 2022
Bon Secours Richmond LLC Organization, Cincinnati, OH LLC 5% Or Greater Indirect Ownership Interest Dec 31, 2014 100%
Michael John Lutes Individual Corporate DirectorBoard Member Jan 1, 2023
Birdie H Jamison Individual Corporate DirectorBoard Member Sep 1, 2018
Devon Henry Individual Corporate DirectorBoard Member Jan 1, 2024
Bon Secours - Richmond Health System Organization, Richmond, VA Corporation 5% Or Greater Direct Ownership Interest Dec 31, 2014 100%
Kimberly M Ralston Individual W-2 Managing EmployeeVP Reimbursement Sep 1, 2018

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 97

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 97

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1525910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600732800000",
    "number": "1013407543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 639991",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452639991",
            "telephone_number": "804-627-5573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9891 GENERAL PULLER HWY",
            "city": "HARTFIELD",
            "state": "VA",
            "postal_code": "230713122",
            "telephone_number": "804-776-9221",
            "fax_number": "804-776-7537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHESAPEAKE HOSPITAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-10",
        "last_updated": "2020-09-22",
        "certification_date": "2020-09-22",
        "status": "A",
        "authorized_official_last_name": "RALSTON",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "SYSTEM DIRECTOR",
        "authorized_official_telephone_number": "419-996-5119"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bon Secours Hartfield Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hartfield, VA

Sources for this page

Verify at the official NPI Registry.