NPIMap

Organization Active NPI

Bon Secours Depaul Medical Center Inc

  • Family Medicine Physician
  • Norfolk, VA
National Provider Identifier
1396172219
Registry record updated May 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BON SECOURS DEPAUL MEDICAL CENTER INC
Doing business as
East Beach Medical Associates
Practice address
4241 E Little Creek Rd
Norfolk, VA 23518-3546
Phone
(757) 738-1200
Fax
(757) 480-3208
NPI assigned
Oct 9, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 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
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

4241 E Little Creek Rd
Norfolk, VA 23518-3546

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
C06209OtherVAGROUP PTAN

Other names 1

  • East Beach Medical Associates Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1381276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557964800000",
    "number": "1396172219",
    "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": "4241 E LITTLE CREEK RD",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235183546",
            "telephone_number": "757-738-1200",
            "fax_number": "757-480-3208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BON SECOURS DEPAUL MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-09",
        "last_updated": "2019-05-16",
        "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": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "C06209",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Beach Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "East Beach Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Norfolk, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2019; 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.