NPIMap

Organization Active NPI

Bon Secours St. Francis Medical Center, Inc.

Doing business as Bon Secours Freedom Healthcare Associates

  • Family Medicine Physician
  • Petersburg, VA
National Provider Identifier
1124421318
Registry record updated Oct 1, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BON SECOURS ST. FRANCIS MEDICAL CENTER, INC.
Doing business as
Bon Secours Freedom Healthcare Associates
Practice address
32 W Washington St
Suite B
Petersburg, VA 23803-4224
Phone
(804) 431-3400
Fax
(804) 733-3858
NPI assigned
Oct 1, 2014
Last updated
Oct 1, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2014

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

Authorized official

Name
George O Butler
Title
Director Corporate Responsibility
Phone
(804) 281-0271

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

32 W Washington St
Suite B
Petersburg, VA 23803-4224

Mailing address

32 W Washington St
Suite B
Petersburg, VA 23803-4224
Phone (804) 431-3400

Other identifiers 1

IdentifierTypeStateIssuer
C09633OtherVAGROUP PTAN

Other names 1

  • Bon Secours Freedom Healthcare Associates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050920000437 VA Part B Supplier - Clinic/Group Practice 0648215418 Receives reassigned benefits from 61 practitioners
21 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chester, VA; Midlothian, VA; Powhatan, VA

Other NPIs on the same Medicare enrollment 21

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

View all 21

National Provider Directory

National Provider Directory

Locations

32 W Washington St
Ste B
Petersburg, VA 23803
Phone (804) 431-3400

Practitioners & affiliated clinicians

Practitioners 1

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": "1412121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412121600000",
    "number": "1124421318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 W WASHINGTON ST",
            "address_2": "SUITE B",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238034224",
            "telephone_number": "804-431-3400",
            "fax_number": "804-733-3858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32 W WASHINGTON ST",
            "address_2": "SUITE B",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238034224",
            "telephone_number": "804-431-3400",
            "fax_number": "804-733-3858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BON SECOURS ST. FRANCIS MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-01",
        "last_updated": "2014-10-01",
        "status": "A",
        "authorized_official_last_name": "BUTLER",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "DIRECTOR CORPORATE RESPONSIBILITY",
        "authorized_official_telephone_number": "804-281-0271"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "C09633",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bon Secours Freedom Healthcare Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Petersburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.