NPIMap

Organization Active NPI

Premise Health of Virginia Medical, P.C

Doing business as Altria Health Clinic

  • General Practice Physician
  • Richmond, VA
National Provider Identifier
1023360112
Registry record updated Aug 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
PREMISE HEALTH OF VIRGINIA MEDICAL, P.C
Doing business as
Altria Health Clinic
Practice address
6601 W Broad St
Richmond, VA 23230-1723
Phone
(804) 484-8891
NPI assigned
Oct 12, 2012
Last updated
Aug 15, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
CHS HEALTH SERVICE, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 15, 2022

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

Authorized official

Name
Jon Leizman
Title
President
Phone
(216) 479-9063

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X Primary

Addresses

Primary practice location

6601 W Broad St
Richmond, VA 23230-1723

Mailing address

5500 Maryland Way
Ste 400
Brentwood, TN 37027-4948

Other names 1

  • Altria Health Clinic Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D1055053Premise Health of Virginia Medical PC6601 West Broad Street, Richmond, VA 23230Certificate of waiverJun 6, 2028

National Provider Directory

National Provider Directory
Tax ID family
Premise Health of Virginia Medical PC23 organizations share this tax ID, including this one
Part of
Google Wellness Center 345

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

Locations

6601 W Broad St
Richmond, VA 23230
Phone (804) 484-8891

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1350000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660521600000",
    "number": "1023360112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 MARYLAND WAY",
            "address_2": "STE 400",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6601 W BROAD ST",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232301723",
            "telephone_number": "804-484-8891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMISE HEALTH OF VIRGINIA MEDICAL, P.C",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHS HEALTH SERVICE, LLC",
        "enumeration_date": "2012-10-12",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-15",
        "status": "A",
        "authorized_official_last_name": "LEIZMAN",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "216-479-9063"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Altria Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Altria Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Richmond, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.