NPIMap

Organization Active NPI

Bon Secours St Mary's Hospital of Richmond LLC

Doing business as Bon Secours Pediatric Dental Associates

  • Pediatric Dentistry
  • Richmond, VA
National Provider Identifier
1265706188
Registry record updated Oct 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
BON SECOURS ST MARY'S HOSPITAL OF RICHMOND LLC
Doing business as
Bon Secours Pediatric Dental Associates
Practice address
6900 Forest Ave
Suite 110
Richmond, VA 23230-1701
Phone
(804) 893-8715
Fax
(804) 285-1292
NPI assigned
Feb 24, 2012
Last updated
Oct 5, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2021

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

Authorized official

Name
Joseph Hardy
Title
Cfo
Phone
(937) 478-2932

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X NU Primary

Addresses

Primary practice location

6900 Forest Ave
Suite 110
Richmond, VA 23230-1701

Mailing address

8580 Magellan Pkwy
Richmond, VA 23227-1149

Other identifiers 1

IdentifierTypeStateIssuer
C06778OtherVAGROUP PTAN

Other names 1

  • Bon Secours Pediatric Dental Associates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040324000566 VA Part B Supplier - Clinic/Group Practice 8527969476 Receives reassigned benefits from 159 practitioners
48 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Richmond, VA; Midlothian, VA; Mechanicsville, VA; Chester, VA; Blackstone, VA

Other NPIs on the same Medicare enrollment 48

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

View all 48

National Provider Directory

National Provider Directory
Tax ID family
Bon Secours St Marys Hosp21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

Practitioners & affiliated clinicians

Practitioners 11

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": "1330041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633392000000",
    "number": "1265706188",
    "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",
            "fax_number": "866-449-0896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6900 FOREST AVE",
            "address_2": "SUITE 110",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232301701",
            "telephone_number": "804-893-8715",
            "fax_number": "804-285-1292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BON SECOURS ST MARY'S HOSPITAL OF RICHMOND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-24",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A",
        "authorized_official_last_name": "HARDY",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "937-478-2932"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "C06778",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bon Secours Pediatric Dental Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bon Secours Pediatric Dental Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 5, 2021; 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.