NPIMap

Organization Active NPI

Virginia Center for Addiction Medicine

  • Addiction Medicine (Internal Medicine) Physician
  • Glen Allen, VA
National Provider Identifier
1477091247
Registry record updated Jan 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X
License
0101246355 Issued in VA
Legal business name
VIRGINIA CENTER FOR ADDICTION MEDICINE
Practice address
4212 Park Place CT
Glen Allen, VA 23060-3314
Phone
(804) 332-5950
Fax
(804) 728-1086
NPI assigned
Feb 1, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2021

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

Authorized official

Name
James Edward Thompson, M.D.NPI 1194913533
Title
Cmo
Phone
(804) 332-5950

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RA0401X 0101246355 VA Primary
Addiction Medicine (Psychiatry & Neurology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084A0401X 0101015030 VA

Addresses

Primary practice location

4212 Park Place CT
Glen Allen, VA 23060-3314

Mailing address

4212 Park Place CT
Glen Allen, VA 23060-3314
Phone (804) 332-5950

Other practice location 1

7280 York Ave
Gloucester, VA 23061-5181
Phone (804) 332-5950

Other names 1

  • Master Center for Addiction Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170421001009 VA Part B Supplier - Clinic/Group Practice 4789960055 Receives reassigned benefits from 21 practitioners
Practice locations: Glen Allen, VA; Tappahannock, VA; Richmond, VA; North Chesterfield, VA; Norfolk, VA; Kilmarnock, VA; Harrisonburg, VA; Hampton, VA…

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
49D2091209Virginia Center for Addiction Medicine4212 Park Place Court, Glen Allen, VA 23060Certificate of waiverFeb 8, 2027

National Provider Directory

National Provider Directory

Locations

4212 Park Place Ct
Glen Allen, VA 23060
Phone (804) 332-5950

6760 Main St
Ste C
Gloucester, VA 23061
Phone (804) 332-5950

7280 York Ave
Gloucester, VA 23061
Phone (804) 332-5950

2208 Executive Dr
Ste E
Hampton, VA 23666
Phone (757) 826-7516

2301 N Parham Rd
Ste 4
Richmond, VA 23229

Practitioners & affiliated clinicians

Practitioners 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1485907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609718400000",
    "number": "1477091247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4212 PARK PLACE CT",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230603314",
            "telephone_number": "804-332-5950",
            "fax_number": "804-728-1086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4212 PARK PLACE CT",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230603314",
            "telephone_number": "804-332-5950",
            "fax_number": "804-728-1086"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7280 York Ave",
            "address_purpose": "LOCATION",
            "city": "Gloucester",
            "state": "VA",
            "postal_code": "230615181",
            "country_code": "US",
            "telephone_number": "804-332-5950",
            "fax_number": "804-728-1086",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "VIRGINIA CENTER FOR ADDICTION MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-01",
        "last_updated": "2021-01-04",
        "certification_date": "2021-01-04",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "CMO",
        "authorized_official_telephone_number": "804-332-5950",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "VA",
            "license": "0101246355",
            "primary": true
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "VA",
            "license": "0101015030",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Master Center for Addiction Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glen Allen, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.