NPIMap

Organization Active NPI

Vernon J Harris East End Community Health Center

Doing business as Capital Area Health Network - Bermuda Medical Center

  • Federally Qualified Health Center (FQHC)
  • North Chesterfield, VA
National Provider Identifier
1710225818
Registry record updated Nov 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
VERNON J HARRIS EAST END COMMUNITY HEALTH CENTER
Doing business as
Capital Area Health Network - Bermuda Medical Center
Practice address
2740 Bensley Commons Blvd
North Chesterfield, VA 23237-1723
Phone
(804) 780-0840
Fax
(804) 780-0862
NPI assigned
Jan 24, 2013
Last updated
Nov 17, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
VERNON J HARRIS EAST END COMMUNITY HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 17, 2022

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

Authorized official

Name
Tracy Causey
Title
Chief Executive Officer
Phone
(804) 253-1968

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

2740 Bensley Commons Blvd
North Chesterfield, VA 23237-1723

Mailing address

2809 North Ave
Richmond, VA 23222-3647
Phone (804) 780-0840

Other names 1

  • Capital Area Health Network - Bermuda Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040217000877 VA Part B Supplier - Clinic/Group Practice 9638064850 Receives reassigned benefits from 49 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: North Chesterfield, VA; Richmond, VA
O20130405000042 VA Part A Provider - Federally Qualified Health Center (FQHC) 9638064850 Practice locations: Chesterfield, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710225818. Details of each certification follow.

Federally qualified health center certification: CCN 491924

Legal name
VERNON J HARRIS EAST END COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 5, 2013
Last certification
Apr 5, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 15, 1999 in VA
Enrollment address
2740 Bensley Commons Blvd
Chesterfield, VA 23234

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 7

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D2062239Bermuda Medical Center2740 Bensley Commons Boulevard, Richmond, VA 23237Provider-performed microscopyJul 27, 2027

National Provider Directory

National Provider Directory
Part of
Vernon J Harris East En

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Dora Bullock Individual Corporate DirectorMember Mar 1, 2013
Vanessa Cabra Individual Corporate DirectorMmber Mar 1, 2013
Willie Hilliard Individual Corporate DirectorMember Mar 1, 2013
Alfreda Cheatham Individual Corporate DirectorMember Mar 1, 2013
Wilma Harris Individual Corporate DirectorMember Mar 1, 2013
Roscoe Cooper Individual Corporate DirectorPres Jul 22, 2008
Tracy Causey Individual Corporate Director Mar 1, 2013
W-2 Managing EmployeeExec Dir Mar 1, 2013
Sharon Dabney-Wooldridge Individual Corporate Director Mar 1, 2013
Daniel Herlihy Individual Corporate DirectorMember Mar 1, 2013
Jeffery Marshall Individual Corporate DirectorPres Mar 1, 2013

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 5

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": "1358985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668643200000",
    "number": "1710225818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2809 NORTH AVE",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232223647",
            "telephone_number": "804-780-0840",
            "fax_number": "804-329-1206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2740 BENSLEY COMMONS BLVD",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232371723",
            "telephone_number": "804-780-0840",
            "fax_number": "804-780-0862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VERNON J HARRIS EAST END COMMUNITY HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VERNON J HARRIS EAST END COMMUNITY HEALTH CENTER",
        "enumeration_date": "2013-01-24",
        "last_updated": "2022-11-17",
        "certification_date": "2022-11-17",
        "status": "A",
        "authorized_official_last_name": "CAUSEY",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "804-253-1968"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Capital Area Health Network - Bermuda Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Chesterfield, VA

Sources for this page

Verify at the official NPI Registry.