Bon Secours Depaul Medical Center LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

BON SECOURS DEPAUL MEDICAL CENTER LLC

Practice address

155 Kingsley LN Ste 400
Norfolk, VA 23505-4629

Phone

(757) 278-2240

Fax

(757) 489-6469

NPI assigned

Mar 16, 2007

Organization subpart

Yes

Parent organization

BON SECOURS DEPAUL MEDICAL CENTER LLCAs reported in NPPES

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

Authorized official

Name

Wilbur Gay

Title

Cfo

Phone

(864) 561-7672

Specialties & licenses 2

Addresses

Other names 1

• DePaul Medical Associates Doing business as

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

CLIA laboratory certificates

Part of

Bon Secours Depaul Med Ctr

Locations

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600732800000",
    "number": "1619001906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8580 MAGELLAN PKWY",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232271149",
            "fax_number": "866-449-0896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 KINGSLEY LN STE 400",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235054629",
            "telephone_number": "757-278-2240",
            "fax_number": "757-489-6469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BON SECOURS DEPAUL MEDICAL CENTER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BON SECOURS DEPAUL MEDICAL CENTER LLC",
        "enumeration_date": "2007-03-16",
        "last_updated": "2020-09-22",
        "certification_date": "2020-09-22",
        "status": "A",
        "authorized_official_last_name": "GAY",
        "authorized_official_first_name": "WILBUR",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "864-561-7672"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DePaul Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DePaul Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bon Secours Depaul Medical Center Inc
• Bon Secours Depaul Medical Center Inc
• Bon Secours Depaul Medical Center Inc
• Bon Secours Depaul Medical Center Inc.
• Bon Secours Depaul Medical Center LLC
• Bon Secours Depaul Medical Center LLC
• Bon Secours Eap
• Bon Secours Private Care
• Naomi Bond, LMT
• Dmitry Bondarenko, MD

• Family Medicine Physician in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Family Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2020; 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.