NPIMap

Organization Active NPI

Glenside Medical Associates, LLC

  • Family Medicine Physician
  • Richmond, VA
National Provider Identifier
1215936901
Registry record updated Sep 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
GLENSIDE MEDICAL ASSOCIATES, LLC
Practice address
4000A Glenside Dr
Richmond, VA 23228-4102
Phone
(804) 262-4763
Fax
(804) 264-9683
NPI assigned
Jul 15, 2005
Last updated
Sep 22, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2023

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

Authorized official

Name
Robin Campbell
Title
Sr Director, Enterprise Revenue Cyc
Phone
(804) 262-4763

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

4000A Glenside Dr
Richmond, VA 23228-4102

Mailing address

4000A Glenside Dr
Richmond, VA 23228-4102
Phone (804) 262-4763

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100222000428 VA Part B Supplier - Clinic/Group Practice 9032253596 Receives reassigned benefits from 10 practitioners
Practice locations: Manakin Sabot, VA; Richmond, VA

National Provider Directory

National Provider Directory

Locations

4000A Glenside Dr
Richmond, VA 23228
Phone (804) 262-4763

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1121385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695340800000",
    "number": "1215936901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000A GLENSIDE DR",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232284102",
            "telephone_number": "804-262-4763",
            "fax_number": "804-264-9683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000A GLENSIDE DR",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232284102",
            "telephone_number": "804-262-4763",
            "fax_number": "804-264-9683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENSIDE MEDICAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-15",
        "last_updated": "2023-09-22",
        "certification_date": "2023-09-22",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "SR DIRECTOR, ENTERPRISE REVENUE CYC",
        "authorized_official_telephone_number": "804-262-4763"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "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 Sep 22, 2023; 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.