NPIMap

Organization Active NPI

Bon Secours St Mary'S Hospital of Richmond LLC

  • Internal Medicine Physician
  • Richmond, VA
National Provider Identifier
1265719504
Registry record updated Oct 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
BON SECOURS ST MARY'S HOSPITAL OF RICHMOND LLC
Practice address
9220 Forest Hill Ave
Suite 1-a
Richmond, VA 23235-6800
Phone
(804) 560-8838
Fax
(804) 560-3527
NPI assigned
Nov 15, 2011
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
Kimberly M Ralston
Title
System Director
Phone
(419) 996-5119

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

9220 Forest Hill Ave
Suite 1-a
Richmond, VA 23235-6800

Mailing address

8580 Magellan Pkwy
Richmond, VA 23227-1149

Other identifiers 1

IdentifierTypeStateIssuer
C06778OtherVAGROUP PTAN

Other names 1

  • Commonwealth Internal Medicine Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

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
O20190507002620 VA Part B Supplier - Mass Immunization (Roster Biller Only) 8527969476 4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Richmond, 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 Hospital of Richmond LLC21 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

Locations

9220 Forest Hill Ave
Richmond, VA 23235
Phone (804) 323-0177

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1321315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633392000000",
    "number": "1265719504",
    "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": "9220 FOREST HILL AVE",
            "address_2": "SUITE 1-A",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232356800",
            "telephone_number": "804-560-8838",
            "fax_number": "804-560-3527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BON SECOURS ST MARY'S HOSPITAL OF RICHMOND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-15",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A",
        "authorized_official_last_name": "RALSTON",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SYSTEM DIRECTOR",
        "authorized_official_telephone_number": "419-996-5119"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "C06778",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Commonwealth Internal Medicine Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Commonwealth Internal Medicine 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.