NPIMap

Organization Active NPI

Mary Immaculate Hospital LLC

  • General Acute Care Hospital
  • Newport News, VA
National Provider Identifier
1427064310
Registry record updated Aug 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
H 1873 Issued in VA
Legal business name
MARY IMMACULATE HOSPITAL LLC
Practice address
2 Bernardine Dr
Newport News, VA 23602-4404
Phone
(757) 886-6500
Fax
(757) 886-6539
NPI assigned
Jul 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2020

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

Authorized official

Name
Kimberly M Ralston
Title
System Director Payor Admin
Phone
(419) 996-5119

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X H 1873 VA Primary

Addresses

Primary practice location

2 Bernardine Dr
Newport News, VA 23602-4404

Mailing address

PO Box 639899
Cincinnati, OH 45263-9899
Phone (804) 627-5462

Other identifiers 1

IdentifierTypeStateIssuer
4900413MedicaidVA

Other names 1

  • MARY IMMACULATE HOSPITAL Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090713000412 VA Part A Provider - Hospital 0042124042 Practice locations: Newport News, VA; Yorktown, VA; Hampton, VA

Hospital certification: CCN 490041

Legal name
MARY IMMACULATE HOSPITAL LLC
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Mar 7, 2011
Beds
110
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Sep 21, 1956 in VA
Enrollment address
2 Bernardine Dr
Newport News, VA 23602-4404
Main/Primary Hospital Location
Hospital subgroups
Acute care

Care Compare: Hospital

Medicare Care Compare
Listed as
Mary Immaculate HospitalCCN 490041
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Mary Immaculate Hospital4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

2 Bernardine Dr
Ste 103
Newport News, VA 23602

14703 Warwick Blvd
Newport News, VA 23608
Phone (757) 886-6012

Ownership & related parties

All disclosed owners & managing parties 18

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Ann M Kirk Individual Corporate DirectorBoard Member Jan 1, 2025
Kevin Clark Individual Corporate DirectorBoard Member Jan 1, 2026
Angela Reddix Individual Corporate DirectorBoard Member Jan 1, 2026
Patricia Davis-Hagens Individual Corporate DirectorBoard Member Oct 18, 2021
David a Cannady Individual Corporate DirectorBoard Member Jan 1, 2023
Brian Yanofchick Individual Corporate DirectorBoard Member Jan 1, 2020
Bon Secours Mercy Health Inc Organization, Cincinnati, OH Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Sep 1, 2018 100%
John Starcher Individual Operational/Managerial ControlCho Admin Sep 1, 2018
Dawn Glynn Individual Corporate DirectorBoard Member Jan 1, 2024
Bon Secours Hampton Roads Health System Inc Organization, Suffolk, VA LLC, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2020 100%
Corey McCray Individual Corporate DirectorBoard Member Jan 1, 2024
Raymond L McCue Individual Corporate DirectorBoard Member Jan 1, 2026
Teresa Beale Individual Corporate DirectorBoard Member Jan 1, 2022
Jonathan L Haynes Individual Corporate OfficerCfo Hampton MKT Jan 1, 2022
Corporate DirectorBoard Member Jan 1, 2022
W-2 Managing EmployeeCfo Hampton MKT Jan 1, 2022
John E Snellings Individual Corporate DirectorBoard Member Jan 1, 2026
Cynthia C Romero Individual Corporate DirectorBoard Member Jan 1, 2016
Kimberly M Ralston Individual W-2 Managing EmployeeVP Reimbursement Sep 1, 2018
Joy L Jefferson Individual Corporate DirectorBoard Member Jan 1, 2025

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 97

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 97

Practitioners & affiliated clinicians

Practitioners 1

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

Affiliated clinicians 316

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 316

NPI Registry JSON

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598486400000",
    "number": "1427064310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 639899",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452639899",
            "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": "2 BERNARDINE DR",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236024404",
            "telephone_number": "757-886-6500",
            "fax_number": "757-886-6539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY IMMACULATE HOSPITAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-31",
        "last_updated": "2020-08-27",
        "certification_date": "2020-08-27",
        "status": "A",
        "authorized_official_last_name": "RALSTON",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SYSTEM DIRECTOR PAYOR ADMIN",
        "authorized_official_telephone_number": "419-996-5119"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "VA",
            "license": "H 1873",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4900413",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MARY IMMACULATE HOSPITAL",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Newport News, VA

Sources for this page

Verify at the official NPI Registry.