NPIMap

Organization Active NPI

Bon Secours-St. Mary'S Hospital of Richmond, Inc.

  • Dermatology Physician
  • Glen Allen, VA
National Provider Identifier
1629377221
Registry record updated Aug 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
BON SECOURS-ST. MARY'S HOSPITAL OF RICHMOND, INC.
Doing business as
Bon Secours Surgical Dermatology Center
Practice address
5207 Hickory Park Dr
Suite a
Glen Allen, VA 23059-2624
Phone
(804) 977-8938
Fax
(804) 762-7102
NPI assigned
Mar 22, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2019

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

Authorized official

Name
Stephan Quiriconi
Title
Cfo
Phone
(804) 281-8301

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

5207 Hickory Park Dr
Suite a
Glen Allen, VA 23059-2624

Mailing address

8580 Magellan Pkwy
Richmond, VA 23227-1149

Other identifiers 1

IdentifierTypeStateIssuer
C06778OtherVAGROUP PTAN

Other names 1

  • Bon Secours Surgical Dermatology Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040324000566 VA Part B Supplier - Clinic/Group Practice 8527969476 Receives reassigned benefits from 159 practitioners
48 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Richmond, VA; Midlothian, VA; Mechanicsville, VA; Chester, VA; Blackstone, VA

Other NPIs on the same Medicare enrollment 48

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

View all 48

National Provider Directory

National Provider Directory

Locations

5207 Hickory Park Dr
Glen Allen, VA 23059

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1300752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567123200000",
    "number": "1629377221",
    "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": "5207 HICKORY PARK DR",
            "address_2": "SUITE A",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230592624",
            "telephone_number": "804-977-8938",
            "fax_number": "804-762-7102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BON SECOURS-ST. MARY'S HOSPITAL OF RICHMOND, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-22",
        "last_updated": "2019-08-30",
        "status": "A",
        "authorized_official_last_name": "QUIRICONI",
        "authorized_official_first_name": "STEPHAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "804-281-8301"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "C06778",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bon Secours Surgical Dermatology Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bon Secours Surgical Dermatology Center",
            "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 Aug 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.