NPIMap

Individual provider Active NPI

William Roger Visser, MD

  • Urology Physician
  • Petersburg, VA
National Provider Identifier
1700374758
Registry record updated Apr 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
0101278183 Issued in VA
Practice address
40 Medical Park Blvd Ste D
Petersburg, VA 23805-9289
Phone
(804) 765-6100
Fax
(804) 765-5373
NPI assigned
Apr 25, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 0101278183 VA Primary

Addresses

Primary practice location

40 Medical Park Blvd Ste D
Petersburg, VA 23805-9289

Mailing address

40 Medical Park Blvd Ste D
Petersburg, VA 23805-9289
Phone (804) 765-6100

Other practice location 1

16000 Johnston Memorial Dr Ste 300
Abingdon, VA 24211-0005
Phone (276) 258-3820

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231002001119 VA Practitioner - Urology 6901153626 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
North Carolina Medical School, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bon Secours Medical Group Richmond Specialty Care LLCGroup PAC ID 8022440056, 350 clinicians

Practice addresses (Care Compare)

1510 N 28TH St
Richmond, VA 23223-5311

281 E Hundred Rd
Chester, VA 23836-2613
Phone (804) 764-7885

40 Medical Park Blvd
Petersburg, VA 23805-9289

511 Belfield Dr
Emporia, VA 23847-1217
Phone (434) 336-1222

Hospital & facility affiliations

  • Bon Secours Southside Medical Center Hospital, Petersburg, VA, CCN 490067
  • Bon Secours St Marys Hospital Hospital, Richmond, VA, CCN 490059
  • Bon Secours St Francis Medical Center Hospital, Midlothian, VA, CCN 490136

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection12
Melanoma (skin cancer) excision1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0101278183VAMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Ridge Medical Management Corporation Current Accepting new patients
Bon Secours Medical Group Richmond Specialty Care LLC CurrentSince Sep 4, 2023 Accepting new patients
Bon Secours Medical Group Richmond Specialty Care LLC CurrentSince Sep 4, 2023 Accepting new patients

Locations

281 E Hundred Rd
Chester, VA 23836
Phone (804) 452-1635

511 Belfield Dr
Emporia, VA 23847
Phone (434) 348-4680

40 Medical Park Blvd
Ste D
Petersburg, VA 23805
Phone (804) 765-5320

1510 N 28th St
Ste 110
Richmond, VA 23223
Phone (804) 545-2304

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 18

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1524614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744761600000",
    "number": "1700374758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 MEDICAL PARK BLVD STE D",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238059289",
            "telephone_number": "804-765-6100",
            "fax_number": "804-765-5373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 MEDICAL PARK BLVD STE D",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238059289",
            "telephone_number": "804-765-6100",
            "fax_number": "804-765-5373"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16000 Johnston Memorial Dr Ste 300",
            "address_purpose": "LOCATION",
            "city": "Abingdon",
            "state": "VA",
            "postal_code": "242110005",
            "country_code": "US",
            "telephone_number": "276-258-3820",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VISSER",
        "first_name": "WILLIAM",
        "middle_name": "ROGER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-25",
        "last_updated": "2025-04-16",
        "certification_date": "2025-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "VA",
            "license": "0101278183",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Petersburg, VA

Sources for this page

Verify at the official NPI Registry.