NPIMap

Organization Active NPI

Riverside Physician Services Inc

Doing business as Riverside Primary Care Midtown

  • Primary Care Clinic/Center
  • Williamsburg, VA
National Provider Identifier
1861414609
Registry record updated Jul 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
RIVERSIDE PHYSICIAN SERVICES INC
Doing business as
Riverside Primary Care Midtown
Practice address
301 College Row Unit 9101
Williamsburg, VA 23185-3694
Phone
(757) 782-6200
Fax
(757) 594-2195
NPI assigned
Jul 24, 2006
Last updated
Jul 27, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
RIVERSIDE PHYSICIAN SERVICES INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 27, 2023

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

Authorized official

Name
Braden Miller
Title
Cfo
Phone
(757) 316-5906

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU Primary

Addresses

Primary practice location

301 College Row Unit 9101
Williamsburg, VA 23185-3694

Mailing address

856 J Clyde Morris Blvd
Suite a
Newport News, VA 23601-1318
Phone (757) 316-5800

Other names 1

  • Riverside Primary Care Midtown 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
49D2283026Riverside Primary Care Midtown301 College Row, Suite 9101, Williamsburg, VA 23185Certificate of waiverMay 30, 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

301 College Row
#9191
Williamsburg, VA 23185

301 College Row
Unit 9101
Williamsburg, VA 23185
Phone (757) 782-6200

Practitioners & affiliated clinicians

Practitioners 12

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": "1153699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690416000000",
    "number": "1861414609",
    "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": "757-316-5800",
            "fax_number": "757-534-5190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 COLLEGE ROW UNIT 9101",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231853694",
            "telephone_number": "757-782-6200",
            "fax_number": "757-594-2195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE PHYSICIAN SERVICES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RIVERSIDE PHYSICIAN SERVICES INC",
        "enumeration_date": "2006-07-24",
        "last_updated": "2023-07-27",
        "certification_date": "2023-07-27",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "BRADEN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "757-316-5906"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverside Primary Care Midtown",
            "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 Jul 27, 2023; 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.