NPIMap

Organization Active NPI

Bon Secours Memorial Regional Medical Center Inc

Doing business as Bon Secours Pediatrics of Mechanicsville

  • Pediatrics Physician
  • Mechanicsville, VA
National Provider Identifier
1174556658
Registry record updated Jul 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER INC
Doing business as
Bon Secours Pediatrics of Mechanicsville
Practice address
7347 Bell Creek Rd Ste 100
Mechanicsville, VA 23111-3504
Phone
(804) 730-4690
Fax
(804) 559-0333
NPI assigned
Jul 8, 2006
Last updated
Jul 10, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 10, 2019

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

Authorized official

Name
Stephan Quiriconi
Title
Cfo
Phone
(804) 281-8301

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X Primary

Addresses

Primary practice location

7347 Bell Creek Rd Ste 100
Mechanicsville, VA 23111-3504

Mailing address

8580 Magellan Pkwy
Richmond, VA 23227-1149
Phone (804) 627-5462

Other identifiers 1

IdentifierTypeStateIssuer
9892OtherVAMEDICARE PTAN

Other names 1

  • Bon Secours Pediatrics of Mechanicsville Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040726000687 VA Part B Supplier - Clinic/Group Practice 6507775293 Receives reassigned benefits from 75 practitioners
26 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kilmarnock, VA; Glen Allen, VA; Richmond, VA; Mechanicsville, VA; King William, VA

Other NPIs on the same Medicare enrollment 23

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

View all 23

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D0933753Bon Secours Pediatrics of Mechanicsville7347 Bell Creek Road - Suite 100, Mechanicsville, VA 23111Certificate of waiverAug 13, 2026

National Provider Directory

National Provider Directory
Part of
Laburnum Medical Center

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": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562716800000",
    "number": "1174556658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8580 MAGELLAN PKWY",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232271149",
            "telephone_number": "804-627-5462",
            "fax_number": "866-449-0896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7347 BELL CREEK RD STE 100",
            "city": "MECHANICSVILLE",
            "state": "VA",
            "postal_code": "231113504",
            "telephone_number": "804-730-4690",
            "fax_number": "804-559-0333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER INC",
        "enumeration_date": "2006-07-08",
        "last_updated": "2019-07-10",
        "status": "A",
        "authorized_official_last_name": "QUIRICONI",
        "authorized_official_first_name": "STEPHAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "804-281-8301"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "9892",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bon Secours Pediatrics of Mechanicsville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mechanicsville, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.