Riverside Physician Services Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

RIVERSIDE PHYSICIAN SERVICES INC

Doing business as

Eagle Harbor Primary Care

Practice address

13478 Carrollton Blvd
Unit D&E
Carrollton, VA 23314-3208

Phone

(757) 238-7043

Fax

(757) 238-7052

NPI assigned

Jul 15, 2006

Last updated

Oct 15, 2014By the provider in NPPES

Organization subpart

Yes

Parent organization

RIVERSIDE HEALTHCARE ASSOCIATESAs reported in NPPES

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

Authorized official

Name

James Lesnick, MD

Title

Vice President

Phone

(757) 594-4006

Specialties & licenses 1

Addresses

Other names 1

• Eagle Harbor Primary Care Doing business as

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

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

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413331200000",
    "number": "1215953872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "856 J CLYDE MORRIS BLVD",
            "address_2": "SUITE A",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236011318",
            "telephone_number": "757-594-4006",
            "fax_number": "757-534-5190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13478 CARROLLTON BLVD",
            "address_2": "UNIT D&E",
            "city": "CARROLLTON",
            "state": "VA",
            "postal_code": "233143208",
            "telephone_number": "757-238-7043",
            "fax_number": "757-238-7052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE PHYSICIAN SERVICES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RIVERSIDE HEALTHCARE ASSOCIATES",
        "enumeration_date": "2006-07-15",
        "last_updated": "2014-10-15",
        "status": "A",
        "authorized_official_last_name": "LESNICK",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "757-594-4006",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eagle Harbor Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in Carrollton, VA
• Providers in Carrollton, VA by specialty
• Family Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2014; 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.