NPIMap

Organization Active NPI

Maryview Hospital LLC

Doing business as Bon Secours Maryview Medical Center

  • General Acute Care Hospital
  • Portsmouth, VA
National Provider Identifier
1750399192
Registry record updated Sep 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
H 1830 Issued in VA
Legal business name
MARYVIEW HOSPITAL LLC
Doing business as
Bon Secours Maryview Medical Center
Maryview Hospital
Practice address
3636 High St
Portsmouth, VA 23707-3236
Phone
(757) 398-2200
Fax
(757) 398-2359
NPI assigned
Aug 3, 2006
Last updated
Sep 24, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2020

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

Authorized official

Name
Kimberly Ralston
Title
System Director
Phone
(419) 996-5119

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X H 1830 VA Primary

Addresses

Primary practice location

3636 High St
Portsmouth, VA 23707-3236

Mailing address

PO Box 639898
Cincinnati, OH 45263-9898
Phone (513) 952-5002

Other identifiers 1

IdentifierTypeStateIssuer
4900171MedicaidVA

Other names 2

  • Bon Secours Maryview Medical Center Doing business as
  • MARYVIEW HOSPITAL Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081203000781 VA Part A Provider - Hospital 5799685632 8 other NPIs on this enrollment
Practice locations: Virginia Beach, VA; Suffolk, VA; Portsmouth, VA; Norfolk, VA; Newport News, VA; Chesapeake, VA; Carrollton, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1750399192. Details of each certification follow.

Hospital certification: CCN 490017

Legal name
MARYVIEW HOSPITAL LLC
Doing business as
BON SECOURS MARYVIEW MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Dec 22, 2014
Beds
346
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Nov 9, 1983 in VA
Enrollment address
3636 High St
Portsmouth, VA 23707-3236
Main/Primary Hospital Location
Hospital subgroups
Acute care

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 8

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Bon Secours Maryview Medical CenterCCN 490017 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Bon Secours Medcare11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5838 Harbour View Blvd
Ste 2
Suffolk, VA 23435

5838 Harbour View Blvd
Ste 210
Suffolk, VA 23435
Phone (757) 541-1900

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Ann M Kirk Individual Corporate DirectorBoard Member Jan 1, 2025
Kevin Clark Individual Corporate DirectorBoard Member Jan 1, 2026
Angela Reddix Individual Corporate DirectorBoard Member Jan 1, 2026
Patricia Davis-Hagens Individual Corporate DirectorBoard Member Oct 18, 2021
David a Cannady Individual Corporate DirectorBoard Member Jan 1, 2023
Brian Yanofchick Individual Corporate DirectorBoard Member Jan 1, 2020
Bon Secours Mercy Health Inc Organization, Cincinnati, OH Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Sep 1, 2018 100%
John Starcher Individual Operational/Managerial ControlCho Admin Sep 1, 2018
Dawn Glynn Individual Corporate DirectorBoard Member Jan 1, 2024
Bon Secours Hampton Roads Health System Inc Organization, Suffolk, VA Corporation 5% Or Greater Direct Ownership Interest Jan 24, 1985 100%
Corey McCray Individual Corporate DirectorBoard Member Jan 1, 2024
Raymond L McCue Individual Corporate DirectorBoard Member Jan 1, 2026
Teresa Beale Individual Corporate DirectorBoard Member Jan 1, 2022
Jonathan L Haynes Individual Corporate OfficerCfo Hampton Market Jan 1, 2022
Corporate DirectorBoard Member Jan 1, 2022
W-2 Managing EmployeeCfo Hampton Market Jan 1, 2022
John E Snellings Individual Corporate DirectorBoard Member Jan 1, 2026
Cynthia C Romero Individual Corporate DirectorBoard Member Jan 1, 2016
Kimberly M Ralston Individual W-2 Managing EmployeeVP Reimbursement Sep 1, 2018
Joy L Jefferson Individual Corporate DirectorBoard Member Jan 1, 2025

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 97

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 97

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.

Affiliated clinicians 734

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 734

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600905600000",
    "number": "1750399192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 639898",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452639898",
            "telephone_number": "513-952-5002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3636 HIGH ST",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237073236",
            "telephone_number": "757-398-2200",
            "fax_number": "757-398-2359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYVIEW HOSPITAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2020-09-24",
        "certification_date": "2020-09-24",
        "status": "A",
        "authorized_official_last_name": "RALSTON",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "SYSTEM DIRECTOR",
        "authorized_official_telephone_number": "419-996-5119"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "VA",
            "license": "H 1830",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4900171",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bon Secours Maryview Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bon Secours Maryview Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MARYVIEW HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portsmouth, VA

Sources for this page

Verify at the official NPI Registry.