NPIMap

Individual provider Active NPI

Stephanie Lane Gallegos, P.A.-C

  • Medical Physician Assistant
  • Richmond, VA
National Provider Identifier
1104051960
Registry record updated Apr 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
0110004398 Issued in VA
Practice address
1501 Maple Ave
Suite 200 NW Mob
Richmond, VA 23226-2553
Phone
(804) 285-2300
Fax
(804) 285-8420
NPI assigned
May 22, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA-082 NM
Medical Physician Assistant 363AM0700X 0110004398 VA Primary

Addresses

Primary practice location

1501 Maple Ave
Suite 200 NW Mob
Richmond, VA 23226-2553

Mailing address

PO Box 71690
Richmond, VA 23255-1690
Phone (804) 285-2300

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
I20160516001250 VA Practitioner - Physician Assistant 7719276765 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bon Secours Medical Group Richmond Specialty Care LLCGroup PAC ID 8022440056, 350 clinicians

Practice addresses (Care Compare)

1501 Maple Ave
Richmond, VA 23226-2553

1510 N 28TH St
Richmond, VA 23223-5311

3400 Haydenpark LN
Henrico, VA 23233-7867
Phone (804) 285-2300

8220 Meadowbridge Rd
Suite 202
Mechanicsville, VA 23116-2340
Phone (804) 285-2300

Hospital & facility affiliations

  • Bon Secours St Marys Hospital Hospital, Richmond, VA, CCN 490059
  • Bon Secours Memorial Regional Medical Center Hospital, Mechanicsville, VA, CCN 490069

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA-082NMMDMedical Physician Assistant
0110004398VAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Bon Secours Medical Group Richmond Specialty Care LLC CurrentSince Nov 8, 2021 Accepting new patients
Bon Secours Medical Group Richmond Specialty Care LLC CurrentSince Nov 8, 2021 Accepting new patients
Tuckahoe Orthopaedic Associates, LTD CurrentSince Mar 22, 2016 Accepting new patients

Locations

3401 Haydenpark Ln
Ste 100
Henrico, VA 23233

8220 Meadowbridge Rd
Ste 202
Mechanicsville, VA 23116
Phone (804) 730-5023

1501 Maple Ave
Ste 101A
Richmond, VA 23226
Phone 80428523001191

1501 Maple Ave
Ste 200
Richmond, VA 23226

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

Interoperability endpoints

  • Direct secure messaging: sgallegos1151286@direct.bsmhealth.org
  • Direct secure messaging: stephaniegallegos@toa.allscriptsdirect.net

Organizations & group practices 3

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 7

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

NPI Registry JSON

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

{
    "created_epoch": "1242950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461024000000",
    "number": "1104051960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 71690",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232551690",
            "telephone_number": "804-285-2300",
            "fax_number": "804-285-8420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 MAPLE AVE",
            "address_2": "SUITE 200 NW MOB",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232262553",
            "telephone_number": "804-285-2300",
            "fax_number": "804-285-8420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLEGOS",
        "first_name": "STEPHANIE",
        "middle_name": "LANE",
        "name_prefix": "Ms.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-22",
        "last_updated": "2016-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NM",
            "license": "PA-082",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110004398",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, VA

Sources for this page

Verify at the official NPI Registry.