NPIMap

Organization Active NPI

Bon Secours Mercy Health Emporia LLC

Doing business as Bon Secours Southern Virginia Medical Center

  • General Acute Care Hospital
  • Emporia, VA
National Provider Identifier
1104461276
Registry record updated Nov 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
BON SECOURS MERCY HEALTH EMPORIA LLC
Doing business as
Bon Secours Southern Virginia Medical Center
Practice address
727 N Main St
Emporia, VA 23847-1274
Phone
(434) 348-4400
NPI assigned
Nov 13, 2019
Last updated
Nov 11, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2021

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
General Acute Care Hospital 282N00000X Primary

Addresses

Primary practice location

727 N Main St
Emporia, VA 23847-1274

Mailing address

PO Box 639858
Cincinnati, OH 45263-9858

Other names 1

  • BON SECOURS SOUTHERN VIRGINIA MEDICAL CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200106000278 VA Part A Provider - Hospital 9537593256 Practice locations: Emporia, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104461276. Details of each certification follow.

Hospital certification: CCN 490097

Legal name
BON SECOURS MERCY HEALTH EMPORIA LLC
Doing business as
BON SECOURS SOUTHERN VIRGINIA MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Sep 29, 1966
Last certification
Oct 10, 2012
Beds
80
Ownership / control type
Private (for profit)
Most recent change of ownership
Jan 1, 2020 (2 total)
Organization structure
LLCNon-profit
Enrollment address
727 N Main St
Emporia, VA 23847-1274
Main/Primary Hospital Location
Hospital subgroups
Acute care

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

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Bon Secours Southern Virginia Medical CenterCCN 490097 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Bon Secours Mercy Health Emporia LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Ownership & related parties

All disclosed owners & managing parties 19

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, Blue Ash, OH Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Jan 1, 2020 100%
John Starcher Individual Operational/Managerial ControlCho Admin Jan 1, 2020
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
Mary Shimo Individual Corporate DirectorBoard Member Apr 22, 2022
Bon Secours Richmond LLC Organization, Marriottsville, MD LLC, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2020 100%
Michael John Lutes Individual Corporate DirectorBoard Member Oct 1, 2022
Devon Henry Individual Corporate DirectorBoard Member Jan 1, 2024
Kimberly M Ralston Individual W-2 Managing EmployeeVP Reimbursement Jan 1, 2020

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

Affiliated clinicians 118

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 118

NPI Registry JSON

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

{
    "created_epoch": "1573603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636588800000",
    "number": "1104461276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 639858",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452639858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "727 N MAIN ST",
            "city": "EMPORIA",
            "state": "VA",
            "postal_code": "238471274",
            "telephone_number": "434-348-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BON SECOURS MERCY HEALTH EMPORIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-13",
        "last_updated": "2021-11-11",
        "certification_date": "2021-11-11",
        "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": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BON SECOURS SOUTHERN VIRGINIA MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Emporia, VA

Sources for this page

Verify at the official NPI Registry.