NPIMap

Organization Active NPI

Burn and Reconstructive Centers of Virginia, PLLC

  • Specialist
  • Richmond, VA
National Provider Identifier
1194346734
Registry record updated Oct 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
BURN AND RECONSTRUCTIVE CENTERS OF VIRGINIA, PLLC
Practice address
7101 Jahnke Rd
Richmond, VA 23225-4017
Phone
(706) 863-9595
Fax
(706) 447-7184
NPI assigned
May 6, 2020
Last updated
Oct 11, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2022

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

Authorized official

Name
Shawn FaganNPI 1265448500
Title
Owner/MD
Phone
(706) 863-9595

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X Primary

Addresses

Primary practice location

7101 Jahnke Rd
Richmond, VA 23225-4017

Mailing address

PO Box 3548
Augusta, GA 30914-3548
Phone (706) 863-9595

Other practice location 1

3651 Wheeler Rd
Augusta, GA 30909-6521
Phone (706) 863-9595

Other practice location 2

3675 J Dewey Gray Cir Ste 300
Augusta, GA 30909-1868
Phone (706) 863-9595

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20201214001767 VA Part B Supplier - Clinic/Group Practice 4688086747 Receives reassigned benefits from 14 practitioners
Practice locations: Richmond, VA
O20220126000161 GA Part B Supplier - Clinic/Group Practice 4688086747 Receives reassigned benefits from 1 practitioner
Practice locations: Augusta, GA

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 27

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.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1588723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665446400000",
    "number": "1194346734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3548",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309143548",
            "telephone_number": "706-863-9595",
            "fax_number": "706-447-7184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7101 JAHNKE RD",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232254017",
            "telephone_number": "706-863-9595",
            "fax_number": "706-447-7184"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3651 Wheeler Rd",
            "address_purpose": "LOCATION",
            "city": "Augusta",
            "state": "GA",
            "postal_code": "309096521",
            "country_code": "US",
            "telephone_number": "706-863-9595",
            "fax_number": "706-447-7184",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3675 J Dewey Gray Cir Ste 300",
            "address_purpose": "LOCATION",
            "city": "Augusta",
            "state": "GA",
            "postal_code": "309091868",
            "country_code": "US",
            "telephone_number": "706-863-9595",
            "fax_number": "706-447-7184",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BURN AND RECONSTRUCTIVE CENTERS OF VIRGINIA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-06",
        "last_updated": "2022-10-11",
        "certification_date": "2022-10-11",
        "status": "A",
        "authorized_official_last_name": "FAGAN",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_title_or_position": "OWNER/MD",
        "authorized_official_telephone_number": "706-863-9595"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2022; 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.