NPIMap

Organization Active NPI

Premise Health of Virginia Medical, P.C

Doing business as Altria Health Center

  • General Practice Physician
  • Chester, VA
National Provider Identifier
1407108509
Registry record updated Aug 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
PREMISE HEALTH OF VIRGINIA MEDICAL, P.C
Doing business as
Altria Health Center
Practice address
4100 Bermuda Hundred Rd
Chester, VA 23836-3245
Phone
(804) 751-1922
NPI assigned
Oct 12, 2012
Last updated
Aug 15, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
CHS HEALTH SERVICES, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 15, 2022

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

Authorized official

Name
Jon Leizman
Title
President
Phone
(216) 479-9063

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X NU Primary

Addresses

Primary practice location

4100 Bermuda Hundred Rd
Chester, VA 23836-3245

Mailing address

5500 Maryland Way
Ste 400
Brentwood, TN 37027-4948

Other names 1

  • Altria Health Center Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D1055054Premise Health of Virginia Medical PC4100 Bermuda Hundred Road, Chester, VA 23836Certificate of waiverJun 6, 2028

National Provider Directory

National Provider Directory
Tax ID family
Premise Health of Virginia Medical PC23 organizations share this tax ID, including this one
Part of
Choose Health Wellness Ctr

Other organizations with this tax ID 22

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

View all 22

Locations

4100 Bermuda Hundred Rd
Chester, VA 23836
Phone (804) 751-1922

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1350000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660521600000",
    "number": "1407108509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 MARYLAND WAY",
            "address_2": "STE 400",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 BERMUDA HUNDRED RD",
            "city": "CHESTER",
            "state": "VA",
            "postal_code": "238363245",
            "telephone_number": "804-751-1922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMISE HEALTH OF VIRGINIA MEDICAL, P.C",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHS HEALTH SERVICES, LLC",
        "enumeration_date": "2012-10-12",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-15",
        "status": "A",
        "authorized_official_last_name": "LEIZMAN",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "216-479-9063"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Altria Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Altria Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chester, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.