NPIMap

Individual provider Active NPI

Roderick Ervin Haithcock, M.D.

  • Internal Medicine Physician
  • Richmond, VA
National Provider Identifier
1801884580
Registry record updated Nov 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
0101029287 Issued in VA
Practice address
505 W. Leigh Street
Suite 303
Richmond, VA 23220
Phone
(804) 644-1333
Fax
(804) 782-1193
NPI assigned
Oct 7, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0101029287 VA Primary

Addresses

Primary practice location

505 W. Leigh Street
Suite 303
Richmond, VA 23220

Mailing address

505 W. Leigh Street
Suite 303
Richmond, VA 23220
Phone (804) 644-1333

Other practice location 1

2230 W Broad St
Ste 103
Richmond, VA 23220-2002
Phone (804) 325-8801

Other identifiers 2

IdentifierTypeStateIssuer
6078460MedicaidVA
C06695OtherVAGROUP PTAN

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
I20101012000934 VA Practitioner - Internal Medicine 6103956123 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Wayne State University School of Medicine, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bon Secours Medical Group Richmond Primary Care LLCGroup PAC ID 3476986613, 91 clinicians

Practice addresses (Care Compare)

1362 Tappahannock Blvd
Tappahannock, VA 22560-9309
Phone (804) 443-5378

7041 Lee Park Rd
Mechanicsville, VA 23111-3682
Phone (804) 746-3505

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Bon Secours St. Mary's Hospital of Richmond LLC Current Accepting new patients
Bon Secours St Marys Hospital of Richmond LLC CurrentSince Jul 1, 2015 Accepting new patients
Bon Secours St Mary's Hospital of Richmond LLC Internal Medicine CurrentSince Jul 1, 2015 Accepting new patients
Bon Secours Medical Group Richmond Primary Care LLC Internal Medicine CurrentSince Jan 1, 2020 Accepting new patients
Bonner and Haithcock, MD.'S , LTD Internal Medicine Past Accepting new patients
Primary Health Group Inc Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

5855 Bremo Rd
Ste 306
Richmond, VA 23226
Phone (804) 287-7644

2230 W Broad St
Ste 103
Richmond, VA 23220
Phone (804) 325-8801

8580 Magellan Pkwy
Richmond, VA 23227
Phone (804) 627-5462

1362 Tappahannock Blvd
Tappahannock, VA 22560
Phone (804) 443-5378

Interoperability endpoints

  • Direct secure messaging: rhaithcock1151742@direct.bsmhealth.org

Organizations & group practices 7

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 25

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

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1128643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732147200000",
    "number": "1801884580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 W. LEIGH STREET",
            "address_2": "SUITE 303",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "23220",
            "telephone_number": "804-644-1333",
            "fax_number": "804-782-1193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 W. LEIGH STREET",
            "address_2": "SUITE 303",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "23220",
            "telephone_number": "804-644-1333",
            "fax_number": "804-782-1193"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2230 W BROAD ST",
            "address_2": "STE 103",
            "address_purpose": "LOCATION",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232202002",
            "country_code": "US",
            "telephone_number": "804-325-8801",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAITHCOCK",
        "first_name": "RODERICK",
        "middle_name": "ERVIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-07",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101029287",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6078460",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "C06695",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, VA

Sources for this page

Verify at the official NPI Registry.