NPIMap

Individual provider Active NPI

Clarence G. Childress, M.D.

  • Infectious Disease Physician
  • Glen Allen, VA
National Provider Identifier
1902996549
Registry record updated Jul 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
0101056147 Issued in VA
Practice address
10150 Staples Mill Rd
Suite E
Glen Allen, VA 23060-3452
Phone
(804) 755-7581
Fax
(804) 755-7586
NPI assigned
Oct 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2012

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0101056147 VA
Infectious Disease Physician 207RI0200X 0101056147 VA Primary
Pediatrics Physician 208000000X 0101056147 VA

Addresses

Primary practice location

10150 Staples Mill Rd
Suite E
Glen Allen, VA 23060-3452

Mailing address

10150 Staples Mill Rd
Suite E
Glen Allen, VA 23060-3452
Phone (804) 755-7581

Other identifiers 2

IdentifierTypeStateIssuer
010012759MedicaidVA
C06115OtherVAGROUP 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
I20080929000642 VA Practitioner - Pediatric MedicinePractitioner - Internal MedicinePractitioner - Infectious Disease 3971670274 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101056147VAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bon Secours Memorial Regional Medical Center LLC Pediatrics CurrentSince Jul 1, 2012 Accepting new patients
Bon Secours - Memorial Regional Medical Center, Inc. CurrentSince Jul 1, 2012 Accepting new patients
Bon Secours Memorial Regional Medical Center Inc Past Accepting new patients
Bon Secours Memorial Regional Medical Center Past Accepting new patients
MCV Associated Physicians Pediatrics PastSince Sep 28, 2021 Accepting new patients
Bon Secours Memorial Regional Medical Center LLC Past Accepting new patients

Locations

10150 Staples Mill Rd
Ste C
Glen Allen, VA 23060
Phone (804) 755-7581

10150 Staples Mill Rd
Ste E
Glen Allen, VA 23060
Phone (804) 755-7581

1041 Sharon Rd
Ste 205
King William, VA 23086
Phone (804) 746-1677

8200 Meadowbridge Rd
Ste 306
Mechanicsville, VA 23116
Phone (804) 764-1253

4630 S Laburnum Ave
Richmond, VA 23231
Phone (804) 226-2444

Interoperability endpoints

  • Direct secure messaging: cchildress1150127@direct.bsmhealth.org

Organizations & group practices 6

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 8

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

Care Compare profile

Medicare Care Compare
Specialty
Pediatric MedicineAlso: Infectious Disease, Internal Medicine
Education
University of Tennessee, HSC, College of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

8580 Magellan Pkwy
Richmond, VA 23227-1149

PO Box
Cincinnati, OH 45263

Hospital & facility affiliations

  • Bon Secours Memorial Regional Medical Center Hospital, Mechanicsville, VA, CCN 490069
  • Bon Secours St Marys Hospital Hospital, Richmond, VA, CCN 490059
  • Henrico Doctors' Hospital Hospital, Richmond, VA, CCN 490118

NPI Registry JSON

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1341964800000",
    "number": "1902996549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10150 STAPLES MILL RD",
            "address_2": "SUITE E",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230603452",
            "telephone_number": "804-755-7581",
            "fax_number": "804-755-7586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10150 STAPLES MILL RD",
            "address_2": "SUITE E",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230603452",
            "telephone_number": "804-755-7581",
            "fax_number": "804-755-7586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHILDRESS",
        "first_name": "CLARENCE",
        "middle_name": "G.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2012-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101056147",
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "VA",
            "license": "0101056147",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101056147",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010012759",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "C06115",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Allen, VA

Sources for this page

Verify at the official NPI Registry.