NPIMap

Organization Active NPI

Bon Secours Memorial Regional Medical Center Inc

Doing business as Bon Secours Behavioral Health Group at Memorial Regional

  • Psychologist
  • Mechanicsville, VA
National Provider Identifier
1376897827
Registry record updated Jul 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER INC
Doing business as
Bon Secours Behavioral Health Group at Memorial Regional
Practice address
8220 Meadowbridge Rd Ste 313
Mechanicsville, VA 23116-2340
Phone
(804) 325-8882
Fax
(804) 764-3280
NPI assigned
Nov 6, 2012
Last updated
Jul 10, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2019

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

Authorized official

Name
Stephan Quiriconi
Title
Cfo
Phone
(804) 281-8301

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X NU Primary

Addresses

Primary practice location

8220 Meadowbridge Rd Ste 313
Mechanicsville, VA 23116-2340

Mailing address

8580 Magellan Pkwy
Richmond, VA 23227-1149
Phone (804) 627-5462

Other identifiers 1

IdentifierTypeStateIssuer
C06115OtherVAGROUP PTAN

Other names 1

  • Bon Secours Behavioral Health Group at Memorial Regional Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040726000687 VA Part B Supplier - Clinic/Group Practice 6507775293 Receives reassigned benefits from 75 practitioners
26 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kilmarnock, VA; Glen Allen, VA; Richmond, VA; Mechanicsville, VA; King William, VA

Other NPIs on the same Medicare enrollment 23

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

View all 23

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1352160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562716800000",
    "number": "1376897827",
    "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",
            "telephone_number": "804-627-5462",
            "fax_number": "866-449-0896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8220 MEADOWBRIDGE RD STE 313",
            "city": "MECHANICSVILLE",
            "state": "VA",
            "postal_code": "231162340",
            "telephone_number": "804-325-8882",
            "fax_number": "804-764-3280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-06",
        "last_updated": "2019-07-10",
        "status": "A",
        "authorized_official_last_name": "QUIRICONI",
        "authorized_official_first_name": "STEPHAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "804-281-8301"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "C06115",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bon Secours Behavioral Health Group at Memorial Regional",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bon Secours Behavioral Health Group at Memorial Regional",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mechanicsville, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2019; 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.