NPIMap

Organization Active NPI

Chesapeake Hospital LLC

Doing business as Bon Secours Kilmarnock Primary Care

  • Rural Health Clinic/Center
  • Kilmarnock, VA
National Provider Identifier
1073003455
Registry record updated Oct 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CHESAPEAKE HOSPITAL LLC
Doing business as
Bon Secours Kilmarnock Primary Care
Practice address
402 N Main St
Kilmarnock, VA 22482
Phone
(804) 435-2651
Fax
(804) 435-2302
NPI assigned
May 11, 2018
Last updated
Oct 15, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 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

402 N Main St
Kilmarnock, VA 22482

Mailing address

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

Other names 1

  • Bon Secours Kilmarnock Primary Care 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
O20180816002165 VA Part A Provider - Rural Health Clinic 8921060427 Practice locations: Kilmarnock, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073003455. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Apr 27, 1973 in VA
Enrollment address
402 N Main St
Kilmarnock, VA 22482
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
Tax ID family
Chesapeake Hospital Corpxs7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

8152 Northumberland Hwy
Heathsville, VA 22473
Phone (804) 580-7200

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 Oct 1, 2022
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 Non-profit 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 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1525996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602720000000",
    "number": "1073003455",
    "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": "402 N MAIN ST",
            "city": "KILMARNOCK",
            "state": "VA",
            "postal_code": "22482",
            "telephone_number": "804-435-2651",
            "fax_number": "804-435-2302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHESAPEAKE HOSPITAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-11",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "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 Kilmarnock Primary Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bon Secours Kilmarnock Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kilmarnock, VA

Sources for this page

Verify at the official NPI Registry.