NPIMap

Organization Active NPI

Maryview Hospital

Doing business as Internist Western Branch

  • Internal Medicine Physician
  • Chesapeake, VA
National Provider Identifier
1508893892
Registry record updated Feb 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MARYVIEW HOSPITAL
Doing business as
Internist Western Branch
Practice address
4020 Raintree Rd
Suite B
Chesapeake, VA 23321-3749
Phone
(757) 465-8450
Fax
(757) 465-8616
NPI assigned
Jun 26, 2006
Last updated
Feb 1, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
MARYVIEW HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 1, 2012

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

Authorized official

Name
Michael K Kerner
Title
Ceo
Phone
(757) 673-5929

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X Primary

Addresses

Primary practice location

4020 Raintree Rd
Suite B
Chesapeake, VA 23321-3749

Mailing address

4020 Raintree Rd
Suite B
Chesapeake, VA 23321-3749
Phone (757) 465-8450

Other names 1

  • Internist Western Branch Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081203000781 VA Part A Provider - Hospital 5799685632 8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Virginia Beach, VA; Suffolk, VA; Portsmouth, VA; Norfolk, VA; Newport News, VA; Chesapeake, VA; Carrollton, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508893892. Details of each certification follow.

Hospital certification: CCN 490017

Legal name
MARYVIEW HOSPITAL LLC
Doing business as
BON SECOURS MARYVIEW MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Dec 22, 2014
Beds
346
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Nov 9, 1983 in VA
Enrollment address
3636 High St
Portsmouth, VA 23707-3236
Main/Primary Hospital Location
Hospital subgroups
Acute care

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Bon Secours Maryview Medical CenterCCN 490017 · All quality measures
Overall star rating
3 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
Part of
Bon Secours Medcare

Locations

2613 Taylor Rd
Ste 201
Chesapeake, VA 23321
Phone (757) 738-1600

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 Corporation 5% Or Greater Direct Ownership Interest Jan 24, 1985 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 Market Jan 1, 2022
Corporate DirectorBoard Member Jan 1, 2022
W-2 Managing EmployeeCfo Hampton Market 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.

Practitioners & affiliated clinicians

Affiliated clinicians 734

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

View all 734

NPI Registry JSON

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328054400000",
    "number": "1508893892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4020 RAINTREE RD",
            "address_2": "SUITE B",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233213749",
            "telephone_number": "757-465-8450",
            "fax_number": "757-465-8616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4020 RAINTREE RD",
            "address_2": "SUITE B",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233213749",
            "telephone_number": "757-465-8450",
            "fax_number": "757-465-8616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYVIEW HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARYVIEW HOSPITAL",
        "enumeration_date": "2006-06-26",
        "last_updated": "2012-02-01",
        "status": "A",
        "authorized_official_last_name": "KERNER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "757-673-5929"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Internist Western Branch",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chesapeake, VA

Sources for this page

Verify at the official NPI Registry.