NPIMap

Individual provider Active NPI

Kevin Charles Harrison, D.O.

  • Internal Medicine Physician
  • Richmond, VA
National Provider Identifier
1073514238
Registry record updated Sep 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
0102201098 Issued in VA
Practice address
9460 Amberdale Drive
Suite C
Richmond, VA 23236
Phone
(804) 276-2470
Fax
(804) 276-2473
NPI assigned
Aug 9, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0102201098 VA Primary

Addresses

Primary practice location

9460 Amberdale Drive
Suite C
Richmond, VA 23236

Mailing address

9460 Amberdale Drive
Suite C
Richmond, VA 23236
Phone (804) 276-2470

Other identifiers 1

IdentifierTypeStateIssuer
142999OtherVAANTHEM PROVEDIER #

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
I20040819000482 VA Practitioner - Internal Medicine 1355314121 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Midwestern University, Chicago College of Osteopathic Med, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Professional Therapies of Roanoke, Inc.Group PAC ID 3375710619, shared by 5 NPIs, 272 clinicians

Practice addresses (Care Compare)

6800 Woodlake Commons Loop
Midlothian, VA 23112-2281
Phone (804) 302-4589

9460 Amberdale Dr
Suite C
North Chesterfield, VA 23236-1259
Phone (804) 276-2470

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0102201098VAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kevin C Harrison, DO PC Internal Medicine CurrentSince Jun 18, 2004 Accepting new patients

Locations

2621 Promenade Pkwy
Midlothian, VA 23113
Phone (804) 594-7046

9460 Amberdale Dr
Ste C
North Chesterfield, VA 23236
Phone (804) 276-2470

Organizations & group practices 1

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 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1254268800000",
    "number": "1073514238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9460 AMBERDALE DRIVE",
            "address_2": "SUITE C",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "23236",
            "telephone_number": "804-276-2470",
            "fax_number": "804-276-2473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9460 AMBERDALE DRIVE",
            "address_2": "SUITE C",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "23236",
            "telephone_number": "804-276-2470",
            "fax_number": "804-276-2473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRISON",
        "first_name": "KEVIN",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-09",
        "last_updated": "2009-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0102201098",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVEDIER #",
            "identifier": "142999",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, VA

Sources for this page

Verify at the official NPI Registry.