NPIMap

Organization Active NPI

Bon Secours Memorial Regional Medical Center

Doing business as Bon Secours Behavioral Health Services

  • Psychiatry Physician
  • Richmond, VA
National Provider Identifier
1730416579
Registry record updated Jun 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER
Doing business as
Bon Secours Behavioral Health Services
Practice address
1500 N 28TH St
3Rd Floor
Richmond, VA 23223-5332
Phone
(804) 371-1675
Fax
(804) 225-1764
NPI assigned
Nov 16, 2009
Last updated
Jun 9, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
BON SECOURS MEMORIAL REGIONAL MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 9, 2011

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

Authorized official

Name
George O. Butler, MBA
Title
Director, Corporate Responsibility
Phone
(804) 281-0271

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X VA Primary

Addresses

Primary practice location

1500 N 28TH St
3Rd Floor
Richmond, VA 23223-5332

Mailing address

1500 N 28TH St
3Rd Floor
Richmond, VA 23223-5332
Phone (804) 371-1675

Other identifiers 1

IdentifierTypeStateIssuer
C06115OtherVAGROUP PTAN

Other names 1

  • Bon Secours Behavioral Health Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040726000687 VA Part B Supplier - Clinic/Group Practice 6507775293 Receives reassigned benefits from 75 practitioners
26 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kilmarnock, VA; Glen Allen, VA; Richmond, VA; Mechanicsville, VA; King William, VA

Other NPIs on the same Medicare enrollment 23

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

View all 23

National Provider Directory

National Provider Directory
Part of
BS-MRMC Ta Westwood Hegrp

Practitioners & affiliated clinicians

Practitioners 2

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": "1258329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307577600000",
    "number": "1730416579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 N 28TH ST",
            "address_2": "3RD FLOOR",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232235332",
            "telephone_number": "804-371-1675",
            "fax_number": "804-225-1764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 N 28TH ST",
            "address_2": "3RD FLOOR",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232235332",
            "telephone_number": "804-371-1675",
            "fax_number": "804-225-1764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER",
        "enumeration_date": "2009-11-16",
        "last_updated": "2011-06-09",
        "status": "A",
        "authorized_official_last_name": "BUTLER",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "O.",
        "authorized_official_title_or_position": "DIRECTOR, CORPORATE RESPONSIBILITY",
        "authorized_official_telephone_number": "804-281-0271",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "C06115",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bon Secours Behavioral Health Services",
            "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 Jun 9, 2011; 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.