NPIMap

Individual provider Active NPI

Christina Lack, FNP-C

  • Family Nurse Practitioner
  • Richmond, VA
National Provider Identifier
1053892844
Registry record updated Oct 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0024176541 Issued in VA
Practice address
5855 Bremo Rd Ste 208
Richmond, VA 23226-1922
Phone
(804) 287-7574
NPI assigned
Aug 28, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 0024176541 VA
Family Nurse Practitioner 363LF0000X 0024176541 VA Primary

Addresses

Primary practice location

5855 Bremo Rd Ste 208
Richmond, VA 23226-1922

Mailing address

1208 N 37TH St
Richmond, VA 23223-7716
Phone (540) 809-5404

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190416001438 VA Practitioner - Nurse Practitioner 7113268343 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1510 N 28TH St
Richmond, VA 23223-5311

5801 Bremo Rd
Richmond, VA 23226-1907
Phone (804) 764-6000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0024176541VAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Bon Secours St Marys Hospital of Richmond LLC CurrentSince Feb 27, 2019 Accepting new patients
Bon Secours St Mary'S Hospital of Richmond LLC CurrentSince Feb 27, 2019 Accepting new patients
Bon Secours Medical Group Richmond Specialty Care LLC CurrentSince Jan 1, 2020 Accepting new patients
Bon Secours Medical Group Richmond Specialty Care LLC CurrentSince Jan 1, 2020 Accepting new patients
Bon Secours St. Mary'S Hospital of Richmond LLC Current Accepting new patients

Locations

1510 N 28th St
Ste 110
Richmond, VA 23223
Phone (804) 545-2304

5855 Bremo Rd
Ste 306
Richmond, VA 23226
Phone (804) 287-7644

5875 Bremo Rd
Ste 311
Richmond, VA 23226
Phone (804) 287-3550

5855 Bremo Rd
Ste 208
Richmond, VA 23226
Phone (804) 287-7574

8580 Magellan Pkwy
Richmond, VA 23227
Phone (804) 627-5462

Interoperability endpoints

  • Direct secure messaging: clack1152899@direct.bsmhealth.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 19

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1535414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729555200000",
    "number": "1053892844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1208 N 37TH ST",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232237716",
            "telephone_number": "540-809-5404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5855 BREMO RD STE 208",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232261922",
            "telephone_number": "804-287-7574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACK",
        "first_name": "CHRISTINA",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-28",
        "last_updated": "2024-10-22",
        "certification_date": "2024-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "VA",
            "license": "0024176541",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024176541",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, VA

Sources for this page

Verify at the official NPI Registry.