NPIMap

Organization Active NPI

Commonwealth Primary Care

  • Family Nurse Practitioner
  • Richmond, VA
National Provider Identifier
1487011367
Registry record updated Jan 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0024172915 Issued in VA
Legal business name
COMMONWEALTH PRIMARY CARE
Practice address
1800 Glenside Dr
Suite 103
Richmond, VA 23226-3769
Phone
(804) 285-7425
Fax
(804) 673-7074
NPI assigned
Jan 22, 2016
Last updated
Jan 22, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2016

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

Authorized official

Name
Dr. Karissa L. Hackelton, M.D.NPI 1740341841
Title
Medical Director/Phyician/Sharehold
Phone
(804) 285-7425

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0024172915 VA Primary

Addresses

Primary practice location

1800 Glenside Dr
Suite 103
Richmond, VA 23226-3769

Mailing address

1800 Glenside Dr
Suite 103
Richmond, VA 23226-3769
Phone (804) 285-7425

Other names 1

  • Commonwealth Extended Care Other name

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
49D2082028Commonwealth Extended Care1800 Glenside Drive - Suite 103, Richmond, VA 23226ComplianceJul 14, 2026

National Provider Directory

National Provider Directory
Tax ID family
Commonwealth Med Assoc12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Locations

1800 Glenside Dr
Ste 103
Richmond, VA 23226
Phone (804) 285-0100

Practitioners & affiliated clinicians

Practitioners 4

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": "1453420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453420800000",
    "number": "1487011367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 GLENSIDE DR",
            "address_2": "SUITE 103",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232263769",
            "telephone_number": "804-285-7425",
            "fax_number": "804-673-7074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 GLENSIDE DR",
            "address_2": "SUITE 103",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232263769",
            "telephone_number": "804-285-7425",
            "fax_number": "804-673-7074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMONWEALTH PRIMARY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-22",
        "last_updated": "2016-01-22",
        "status": "A",
        "authorized_official_last_name": "HACKELTON",
        "authorized_official_first_name": "KARISSA",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR/PHYICIAN/SHAREHOLD",
        "authorized_official_telephone_number": "804-285-7425",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024172915",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Commonwealth Extended Care",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Richmond, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2016; 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.