Active NPI
Chesapeake Hospital LLC
- Family Medicine Physician
- Lively, VA
National Provider Identifier
1043700347
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- CHESAPEAKE HOSPITAL LLC
- Practice address
- 36 Lively Oaks Rd
Lively, VA 22507 - Phone
- (804) 462-5155
- Fax
- (804) 462-5922
- NPI assigned
- May 14, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kimberly M Ralston
- Title
- Director Reimbursement
- Phone
- (419) 996-5119
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
36 Lively Oaks Rd
Lively, VA 22507
Mailing address
8580 Magellan Pkwy
Richmond, VA 23227-1149
Phone (804) 627-5573
Other names 1
- Bon Secours Lively Medical Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
Other NPIs on the same Medicare enrollment 9
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Family Medicine Physician
- Kilmarnock, VA
- NPI 1003306358
O20041027001018
-
- Emergency Medicine Physician
- Kilmarnock, VA
- NPI 1558532119
O20041027001018
-
- Family Medicine Physician
- Heathsville, VA
- NPI 1770073025
O20041027001018
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1526256000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1605830400000",
"number": "1043700347",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8580 MAGELLAN PKWY",
"city": "RICHMOND",
"state": "VA",
"postal_code": "232271149",
"telephone_number": "804-627-5573",
"fax_number": "866-449-0896"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36 LIVELY OAKS RD",
"city": "LIVELY",
"state": "VA",
"postal_code": "22507",
"telephone_number": "804-462-5155",
"fax_number": "804-462-5922"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CHESAPEAKE HOSPITAL LLC",
"organizational_subpart": "NO",
"enumeration_date": "2018-05-14",
"last_updated": "2020-11-20",
"certification_date": "2020-11-20",
"status": "A",
"authorized_official_last_name": "RALSTON",
"authorized_official_first_name": "KIMBERLY",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "DIRECTOR REIMBURSEMENT",
"authorized_official_telephone_number": "419-996-5119"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Bon Secours Lively Medical Center",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Bon Secours Lively Medical Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Lively, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.