NPIMap

Organization Active NPI

Riverside Physician Services Inc

Doing business as Riverside Urogynecology Specialists Williamsburg

  • Urology Physician
  • Williamsburg, VA
National Provider Identifier
1801817663
Registry record updated Sep 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
RIVERSIDE PHYSICIAN SERVICES INC
Doing business as
Riverside Urogynecology Specialists Williamsburg
Practice address
3700 Battery Blvd Ste 304
Williamsburg, VA 23185-4888
Phone
(757) 612-7340
Fax
(757) 933-8376
NPI assigned
Jul 21, 2006
Last updated
Sep 30, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
RIVERSIDE PHYSICIAN SERVICES INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 30, 2024

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

Authorized official

Name
Billie Jo Brown
Title
Credentialing Manager
Phone
(757) 316-5901

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology Physician 207VG0400X
Urology Physician 208800000X Primary

Addresses

Primary practice location

3700 Battery Blvd Ste 304
Williamsburg, VA 23185-4888

Mailing address

856 J Clyde Morris Blvd
Suite a
Newport News, VA 23601-1318
Phone (757) 594-4006

Other names 1

  • Riverside Urogynecology Specialists Williamsburg Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040207000400 VA Part B Supplier - Clinic/Group Practice 5092608448 Receives reassigned benefits from 1,191 practitioners
This NPI is an additional NPI on the enrollment

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
49D2316836Riverside Urogynecology Specialists-Williamsburg3700 Battery Boulevard, Suite 304, Williamsburg, VA 23185Certificate of waiverJan 13, 2027

National Provider Directory

National Provider Directory
Part of
Riverside OB-GYN

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

858 J Clyde Morris Blvd
Newport News, VA 23601
Phone (757) 594-4343

Practitioners & affiliated clinicians

Practitioners 63

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.

View all 63

NPI Registry JSON

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727654400000",
    "number": "1801817663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "856 J CLYDE MORRIS BLVD",
            "address_2": "SUITE A",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236011318",
            "telephone_number": "757-594-4006",
            "fax_number": "757-534-5190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 BATTERY BLVD STE 304",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231854888",
            "telephone_number": "757-612-7340",
            "fax_number": "757-933-8376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE PHYSICIAN SERVICES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RIVERSIDE PHYSICIAN SERVICES INC",
        "enumeration_date": "2006-07-21",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-30",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "BILLIE JO",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "757-316-5901"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverside Urogynecology Specialists Williamsburg",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Williamsburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.