NPIMap

Organization Active NPI

Bon Secours-St. Mary's Hospital of Richmond, Inc.

Doing business as Liver Institute of Virginia - Bon Secours Medical Group

  • Hepatology Physician
  • Newport News, VA
National Provider Identifier
1326379769
Registry record updated Oct 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hepatology PhysicianTaxonomy code 207RI0008X
License
0101036976 Issued in VA
Legal business name
BON SECOURS-ST. MARY'S HOSPITAL OF RICHMOND, INC.
Doing business as
Liver Institute of Virginia - Bon Secours Medical Group
Practice address
12720 McManus Blvd
Suite 313
Newport News, VA 23602-4414
Phone
(757) 947-3190
Fax
(757) 947-3195
NPI assigned
Jan 25, 2010
Last updated
Oct 24, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2018

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

Authorized official

Name
George O. Butler, MBA
Title
Director, Corporate Responsibility
Phone
(804) 281-0271

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hepatology Physician 207RI0008X 0101036976 VA Primary

Addresses

Primary practice location

12720 McManus Blvd
Suite 313
Newport News, VA 23602-4414

Mailing address

12720 McManus Blvd
Suite 313
Newport News, VA 23602-4414
Phone (757) 947-3190

Other identifiers 1

IdentifierTypeStateIssuer
C06778OtherVAMEDICARE GROUP PIN

Other names 1

  • Liver Institute of Virginia - Bon Secours Medical Group 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

Locations

12720 McManus Blvd
Ste 313
Newport News, VA 23602
Phone (757) 947-3190

NPI Registry JSON

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

{
    "created_epoch": "1264377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540339200000",
    "number": "1326379769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12720 MCMANUS BLVD",
            "address_2": "SUITE 313",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236024414",
            "telephone_number": "757-947-3190",
            "fax_number": "757-947-3195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12720 MCMANUS BLVD",
            "address_2": "SUITE 313",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236024414",
            "telephone_number": "757-947-3190",
            "fax_number": "757-947-3195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BON SECOURS-ST. MARY'S HOSPITAL OF RICHMOND, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-25",
        "last_updated": "2018-10-24",
        "status": "A",
        "authorized_official_last_name": "BUTLER",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "O.",
        "authorized_official_title_or_position": "DIRECTOR, CORPORATE RESPONSIBILITY",
        "authorized_official_telephone_number": "804-281-0271",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "207RI0008X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hepatology",
            "state": "VA",
            "license": "0101036976",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PIN",
            "identifier": "C06778",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Liver Institute of Virginia - Bon Secours Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Liver Institute of Virginia - Bon Secours Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newport News, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2018; 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.