NPIMap

Organization Active NPI

County of Chesterfield Virginia

  • Geriatric Psychiatry Physician
  • Chesterfield, VA
National Provider Identifier
1336293000
Registry record updated Aug 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Psychiatry PhysicianTaxonomy code 2084P0805X
License
222-07-004 Issued in VA
Legal business name
COUNTY OF CHESTERFIELD VIRGINIA
Practice address
6801 Lucy Corr CT
Chesterfield, VA 23832-6657
Phone
(804) 748-1227
Fax
(804) 717-6659
NPI assigned
Jan 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2017

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

Authorized official

Name
Mrs. Debbie Burcham
Title
Executive Director
Phone
(804) 768-7220

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X 222-07-004 VA
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X 222-07-004 VA
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 222-07-004 VA
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X 222-07-004 VA
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X 222-07-004 VA
Child & Adolescent Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0804X 222-07-004 VA
Geriatric Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0805X 222-07-004 VA Primary
Community/Behavioral Health Agency 251S00000X 222-02-001 VA

Addresses

Primary practice location

6801 Lucy Corr CT
Chesterfield, VA 23832-6657

Mailing address

6801 Lucy Corr CT
Chesterfield, VA 23832-6657
Phone (804) 748-1227

Other identifiers 2

IdentifierTypeStateIssuer
C00801OtherVAMEDICARE GROUP PTAN
1336293000MedicaidVA

Other names 1

  • Chesterfield Community Services Board Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040621000919 VA Part B Supplier - Clinic/Group Practice 0547245946 Receives reassigned benefits from 16 practitioners
2 other NPIs on this enrollment
Practice locations: Chesterfield, VA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Chesterfield County Mental Health9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

9711 Farrar Ct
Ste 140
North Chesterfield, VA 23236
Phone (804) 768-7205

Practitioners & affiliated clinicians

Practitioners 44

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

View all 44

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1502755200000",
    "number": "1336293000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6801 LUCY CORR CT",
            "city": "CHESTERFIELD",
            "state": "VA",
            "postal_code": "238326657",
            "telephone_number": "804-748-1227",
            "fax_number": "804-717-6659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6801 LUCY CORR CT",
            "city": "CHESTERFIELD",
            "state": "VA",
            "postal_code": "238326657",
            "telephone_number": "804-748-1227",
            "fax_number": "804-717-6659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF CHESTERFIELD VIRGINIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2017-08-15",
        "status": "A",
        "authorized_official_last_name": "BURCHAM",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "804-768-7220",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "222-07-004",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "VA",
            "license": "222-07-004",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "222-07-004",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "VA",
            "license": "222-07-004",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "VA",
            "license": "222-07-004",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "VA",
            "license": "222-07-004",
            "primary": false
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "VA",
            "license": "222-07-004",
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "VA",
            "license": "222-02-001",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "C00801",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1336293000",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chesterfield Community Services Board",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chesterfield, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2017; 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.