NPIMap

Organization Active NPI

Virginia Commonwealth University Health System

Doing business as VCU Sports Medicine-VCU Sports Medicine

  • Clinic/Center
  • Richmond, VA
National Provider Identifier
1336367630
Registry record updated Dec 31, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
H1875 Issued in VA
Legal business name
VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM
Doing business as
VCU Sports Medicine-VCU Sports Medicine
Practice address
1300 W Broad St
Richmond, VA 23284-9089
Phone
(804) 828-6315
NPI assigned
Apr 23, 2007
Last updated
Dec 31, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2010

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

Authorized official

Name
Mr. Dominic J Puleo
Title
Cfo
Phone
(804) 828-1295

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X H1875 VA Primary

Addresses

Primary practice location

1300 W Broad St
Richmond, VA 23284-9089

Mailing address

PO Box 758997
Baltimore, MD 21275-0001

Other identifiers 2

IdentifierTypeStateIssuer
442277OtherVAANTHEM-VCU SPORTS MEDICINE
180914OtherVAANTHEM

Other names 1

  • VCU Sports Medicine-VCU Sports Medicine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Vcu Health System Autho35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

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

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1293753600000",
    "number": "1336367630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 758997",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212750001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 W BROAD ST",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232849089",
            "telephone_number": "804-828-6315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2010-12-31",
        "status": "A",
        "authorized_official_last_name": "PULEO",
        "authorized_official_first_name": "DOMINIC",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "804-828-1295",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "VA",
            "license": "H1875",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM-VCU SPORTS MEDICINE",
            "identifier": "442277",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "180914",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VCU Sports Medicine-VCU Sports Medicine",
            "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 Dec 31, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.