NPIMap

Chesapeake Hospital LLC

Organization Active NPI Rural Health Clinic/Center · Kilmarnock, VA

NPI 1073003455 · NPPES record last updated Oct 15, 2020

Key facts

NPI
1073003455
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
CHESAPEAKE HOSPITAL LLC
Practice address
402 N Main St
Kilmarnock, VA 22482
Phone
(804) 435-2651
Fax
(804) 435-2302
NPI assigned
May 11, 2018
Organization subpart
No

Authorized official

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

Owners & managing parties with NPI records 1

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

Other NPIs on the same Medicare enrollment 9

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

Other NPIs with the same Medicare PAC ID 6

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

Corporate family (same tax ID) 6

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

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

Facilities with the same owner 97

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

View all 97

Practitioners 17

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in VA

Rural health clinic certification: CCN 493434

Legal name
CHESAPEAKE HOSPITAL LLC
Doing business as
BON SECOURS KILMARNOCK PRIMARY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 27, 2018
Last certification
Nov 27, 2018
Ownership / control type
2B
Organization structure
Corporation · Non-profit
Incorporated
Apr 27, 1973 in VA
Enrollment address
402 N Main St
Kilmarnock, VA 22482
Related CCNs
491308

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 Director
Board Member		 Jan 1, 2024
Rebecca W McDonough
Individual 		Corporate Director
Board Member		 Jan 1, 2025
Paula P Pando
Individual 		Corporate Director
Board Member		 Jan 1, 2025
Robert Ukrop
Individual 		Corporate Director
Board Member		 Jan 1, 2025
Wael N Haidar
Individual 		Corporate Director
Board Member		 Jan 1, 2023
Osman Parvaiz
Individual 		Corporate Director
Board Member		 Jan 1, 2025
Lang R Liebman
Individual 		Corporate Director
Board Member		 Jan 1, 2022
James Carter
Individual 		Corporate Director
Board Member		 Jan 1, 2025
Brian Yanofchick
Individual 		Corporate Director
Board 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 Control
Cho Admin		 Sep 1, 2018
Regina J Elbert
Individual 		Corporate Director
Board Member		 Jan 1, 2022
Michael Quinones
Individual 		Corporate Director
Board Member		 Jan 1, 2023
William Kusnierz
Individual 		Corporate Officer
Cfo Richmond MKT		 Sep 8, 2020
Corporate Director
Cfo Richmond MKT		 Sep 8, 2020
W-2 Managing Employee
Cfo Richmond MKT		 Sep 8, 2020
Mary Shimo
Individual 		Corporate Director
Board 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 Director
Board Member		 Oct 1, 2022
Birdie H Jamison
Individual 		Corporate Director
Board Member		 Sep 1, 2018
Devon Henry
Individual 		Corporate Director
Board Member		 Jan 1, 2024
Bon Secours - Richmond Health System
Organization · Richmond, VA
Non-profit 		5% Or Greater Direct Ownership Interest Dec 31, 2014 100%
Kimberly M Ralston
Individual 		W-2 Managing Employee
VP Reimbursement		 Sep 1, 2018

Medicare enrollment records

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
O20180816002165 VA Part a Provider - Rural Health Clinic 8921060427 Practice locations: Kilmarnock, VA

National Provider Directory

Tax ID family
RGH Emergency Physician (7 organizations share this tax ID)

Locations

402 N Main St
Kilmarnock, VA 22482
Phone (804) 435-2651

Specialties & licenses

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

Addresses

Primary practice location

402 N Main St
Kilmarnock, VA 22482

Mailing address

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

Other names

  • Bon Secours Kilmarnock Primary Care Doing business as

Other providers in Kilmarnock, VA

All providers in Kilmarnock, VA · Rural Health Clinic/Center in Virginia

Sources for this page

Verify at the official NPI Registry.