NPIMap

Organization Active NPI

Bon Secours St Mary's Hospital of Richmond LLC

Doing business as Pediatric Lung Care - Bon Secours Medical Group

  • Pediatric Pulmonology Physician
  • Richmond, VA
National Provider Identifier
1699906875
Registry record updated Sep 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Pulmonology PhysicianTaxonomy code 2080P0214X
Legal business name
BON SECOURS ST MARY'S HOSPITAL OF RICHMOND LLC
Doing business as
Pediatric Lung Care - Bon Secours Medical Group
Practice address
5875 Bremo Rd Ste 104
Mob South
Richmond, VA 23226-1934
Phone
(804) 287-7770
Fax
(804) 287-7801
NPI assigned
Aug 5, 2009
Last updated
Sep 3, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
BON SECOURS ST MARY'S HOSPITAL OF RICHMOND LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 3, 2020

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Pulmonology Physician 2080P0214X NU Primary

Addresses

Primary practice location

5875 Bremo Rd Ste 104
Mob South
Richmond, VA 23226-1934

Mailing address

8580 Magellan Pkwy
Richmond, VA 23227-1149

Other identifiers 1

IdentifierTypeStateIssuer
C06778OtherVAGROUP PTAN

Other names 1

  • Pediatric Lung Care - Bon Secours Medical Group 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
Part of
Bon Secours St Marys Hosp

Practitioners & affiliated clinicians

Practitioners 10

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": "1249430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599091200000",
    "number": "1699906875",
    "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": "5875 BREMO RD STE 104",
            "address_2": "MOB SOUTH",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232261934",
            "telephone_number": "804-287-7770",
            "fax_number": "804-287-7801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BON SECOURS ST MARY'S HOSPITAL OF RICHMOND LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BON SECOURS ST MARY'S HOSPITAL OF RICHMOND LLC",
        "enumeration_date": "2009-08-05",
        "last_updated": "2020-09-03",
        "certification_date": "2020-09-03",
        "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": "2080P0214X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "C06778",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Lung Care - Bon Secours Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pediatric Lung Care - Bon Secours Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Sep 3, 2020; 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.