NPIMap

Organization Active NPI

Bon Secours-St. Mary'S Hospital of Richmond, Inc.

  • Surgery Physician
  • Richmond, VA
National Provider Identifier
1962633149
Registry record updated Oct 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
BON SECOURS-ST. MARY'S HOSPITAL OF RICHMOND, INC.
Practice address
5855 Bremo Rd
Mob North, Suite 406
Richmond, VA 23226-1930
Phone
(804) 285-4133
Fax
(804) 622-2224
NPI assigned
Aug 5, 2009
Organization subpart
Yes
Parent organization
BON SECOURS-ST. MARY'S HOSPITAL OF RICHMOND, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 24, 2018

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

Authorized official

Name
George O. Butler, MBA
Title
Director, Corporate Responsibility
Phone
(804) 281-0271

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

5855 Bremo Rd
Mob North, Suite 406
Richmond, VA 23226-1930

Mailing address

5855 Bremo Rd
Mob North, Suite 406
Richmond, VA 23226-1930
Phone (804) 285-4133

Other identifiers 1

IdentifierTypeStateIssuer
C06778OtherVAGROUP PTAN

Other names 1

  • Dominion Surgical Associates - Bon Secours Medical Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040324000566 VA Part B Supplier - Clinic/Group Practice 8527969476 Receives reassigned benefits from 159 practitioners
48 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Richmond, VA; Midlothian, VA; Mechanicsville, VA; Chester, VA; Blackstone, VA

Other NPIs on the same Medicare enrollment 48

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

View all 48

National Provider Directory

National Provider Directory
Part of
Bon Secours St Marys Hospital of Richmond LLC

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1249430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540339200000",
    "number": "1962633149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5855 BREMO RD",
            "address_2": "MOB NORTH, SUITE 406",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232261930",
            "telephone_number": "804-285-4133",
            "fax_number": "804-622-2224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5855 BREMO RD",
            "address_2": "MOB NORTH, SUITE 406",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232261930",
            "telephone_number": "804-285-4133",
            "fax_number": "804-622-2224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BON SECOURS-ST. MARY'S HOSPITAL OF RICHMOND, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BON SECOURS-ST. MARY'S HOSPITAL OF RICHMOND, INC.",
        "enumeration_date": "2009-08-05",
        "last_updated": "2018-10-24",
        "status": "A",
        "authorized_official_last_name": "BUTLER",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "O.",
        "authorized_official_title_or_position": "DIRECTOR, CORPORATE RESPONSIBILITY",
        "authorized_official_telephone_number": "804-281-0271",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "C06778",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dominion Surgical Associates - Bon Secours Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dominion Surgical Associates - Bon Secours Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Richmond, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.