BON SECOURS DEPAUL MEDICAL CENTER INC (NPI# 1598051518) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598051518 |
| Entity Type | Organization |
| Organization Name | BON SECOURS DEPAUL MEDICAL CENTER INC |
| Other Organization Name | BON SECOURS PULMONARY ASSOCIATES |
| Practice Address |
150 Kingsley Ln Norfolk VA 23505-4602 |
| Mailing Address |
8580 Magellan Pkwy Richmond VA 23227-1149 |
| Practice Telephone | 7574845900 |
| Practice Fax Number | 7574836671 |
| Mailing Fax Number | 8664490896 |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2019-10-09 |
| Authorized Official Name | STEPHAN QUIRICONI (CFO) |
| Authorized Official Telephone | 8042818301 |
| Is Organization Subpart | Y |
| Parent Organization Name | BON SECOURS DEPAUL MEDICAL CENTER INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Bon Secours Pulmonary Associates | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124438437 | Bon Secours Depaul Medical Center Inc | Family Medicine | 4211 Monarch Way, Norfolk, VA 23508-2540 | 2014-05-08 |
| 1205246519 | Bon Secours Depaul Medical Center Inc | Physical Medicine & Rehabilitation | 908 Eden Way N Ste 100, Chesapeake, VA 23320-3336 | 2014-05-08 |
| 1396172219 | Bon Secours Depaul Medical Center Inc | Family Medicine | 4241 E Little Creek Rd, Norfolk, VA 23518-3546 | 2013-10-09 |
| 1245467521 | Bon Secours Depaul Medical Center Inc | Obstetrics & Gynecology | 100 Kingsley Ln Ste 100, Norfolk, VA 23505-4604 | 2009-06-15 |
| 1316182835 | Bon Secours Depaul Medical Center Inc | Internal Medicine | 100 Kingsley Ln Ste 400, Norfolk, VA 23505-4604 | 2008-12-12 |
| 1154521854 | Bon Secours Depaul Medical Center Inc | Internal Medicine | 828 Healthy Way Ste 220, Virginia Beach, VA 23462-7960 | 2007-07-20 |
| 1922202571 | Bon Secours Depaul Medical Center Inc | Family Medicine | 4421 Virginia Beach Blvd Ste 114, Virginia Beach, VA 23462-3114 | 2007-06-14 |
| 1215494380 | Bon Secours Depaul Medical Center Inc | Surgery | 930 W 21st St Ste 100, Norfolk, VA 23517-1516 | 2019-02-26 |
| 1437525359 | Bon Secours Depaul Medical Center Inc | General Acute Care Hospital | 150 Kingsley Ln, Norfolk, VA 23505-4602 | 2015-08-14 |
| 1144630450 | Bon Secours Depaul Medical Center Inc | Family Medicine | 4421 Virginia Beach Blvd Ste 114, Virginia Beach, VA 23462-3114 | 2014-05-08 |
| Street Address |
150 KINGSLEY LN |
| City | NORFOLK |
| State | VA |
| Zip Code | 23505-4602 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003812785 | Patrick B. Higdon | Family Medicine | 150 Kingsley Ln, Norfolk, VA 23505-4602 | 2005-06-27 |
| 1497385033 | Jennifer L Lemasters-stover | Nurse Practitioner | 150 Kingsley Ln, Norfolk, VA 23505-4602 | 2020-01-23 |
| 1356813083 | Sarah West Taylor | Clinical Nurse Specialist | 150 Kingsley Ln, Norfolk, VA 23505-4602 | 2018-12-19 |
| 1619443009 | Amarachi G Agbai | Registered Nurse | 150 Kingsley Ln, Norfolk, VA 23505-4602 | 2018-10-23 |
| 1043795867 | Lindsey Reprogle | Physician Assistant | 150 Kingsley Ln, Norfolk, VA 23505-4602 | 2018-09-27 |
| 1528549219 | Chika I Ogbolu | Nurse Practitioner | 150 Kingsley Ln, Norfolk, VA 23505-4602 | 2018-08-22 |
| 1457846024 | Gia Martin | Nurse Practitioner | 150 Kingsley Ln, Norfolk, VA 23505-4602 | 2018-06-26 |
| 1295237477 | Shannon Coulson | Nurse Practitioner | 150 Kingsley Ln, Norfolk, VA 23505-4602 | 2018-03-05 |
| 1053834960 | Kathryn Alise Gale | Nurse Practitioner | 150 Kingsley Ln, Norfolk, VA 23505-4602 | 2017-07-23 |
| 1881139434 | Corinna Brander | Nurse Practitioner | 150 Kingsley Ln, Neuroscience Office, Norfolk, VA 23505-4602 | 2017-01-05 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154844256 | Cassandra Shelton | Specialist/Technologist, Other | 100 Kingsley Lane, Norfolk, VA 23505 | 2017-07-20 |
| 1063942852 | Gabriela Marie Santiago | Specialist/Technologist | 7600 Victory Dr, Apt 3, Norfolk, VA 23505 | 2017-06-14 |
| 1144776725 | Amr Hassan | Pharmacist | 1610 W Little Creek Rd, Apt 204, Norfolk, VA 23505 | 2016-09-01 |
| 1992175095 | Heather Mitchell | Nurse Practitioner | 110 Kingsley Ln Ste 309, Norfolk, VA 23505 | 2015-10-01 |
| 1255710620 | Jessica Ann Kestranek | Dentist | 7400 Granby St Ste D, Norfolk, VA 23505 | 2015-05-19 |
| 1710375274 | Carla Toledo | Nurse Practitioner | 155 Kingsley Lane, Suite 400, Norfolk, VA 23505 | 2015-01-06 |
| 1417359746 | James Austin Valone Jr. | Ophthalmology | 1423 Runymede Rd, Norfolk, VA 23505 | 2014-09-18 |
| 1861813370 | Harris Teeter, LLC | Pharmacy | 7550 Granby Street, Norfolk, VA 23505 | 2013-12-31 |
| 1649549361 | Linda Horsey | Social Worker | 7510 Granby Street, Suite 6, Norfolk, VA 23505 | 2011-12-27 |
| 1679705164 | Carolyn Lee Kee | Nurse's Aide | 7403 Hampton Blvd, Norfolk, VA 23505 | 2009-08-17 |
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| Taxonomy Code | 207RP1001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Pulmonary Disease |
| An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003931981 | Virginia Medical Specialist, Plc | Internal Medicine | 160 Kingsley Ln Ste 103, Norfolk, VA 23505-4600 | 2007-03-20 |
| 1548505035 | Timothy Stephen Fusiak | Internal Medicine | 600 Gresham Dr, Ste 8630b, Norfolk, VA 23507-1904 | 2012-12-10 |
| 1598031312 | Zachary Gales | Internal Medicine | 100 Kingsley Ln Ste 400, Norfolk, VA 23505-4604 | 2012-03-26 |
| 1881899557 | Rutul Shah | Internal Medicine | 150 Kingsley Ln, Norfolk, VA 23505-4602 | 2007-06-20 |
| 1467656686 | Fawad Aleem Chaudry | Internal Medicine | 110 N 29th St, Suite 204, Norfolk, NE 68701-4424 | 2007-06-12 |
| 1235255290 | Sherif Omar El Mahdy | Internal Medicine | 600 Gresham Dr, Suite 8630, Norfolk, VA 23507 | 2007-03-21 |
| 1801943782 | Michael H Hooper | Internal Medicine | 855 W Brambleton Ave, Norfolk, VA 23510-1005 | 2007-01-04 |
| 1194819664 | Jeffrey Yale Schnader | Internal Medicine | 825 Fairfax Ave, Suite 445, Norfolk, VA 23507-1914 | 2006-10-02 |
| 1457451437 | Carlos A. Silva | Internal Medicine | 160 Kingsley Ln, Suite 103, Norfolk, VA 23505-4600 | 2006-09-22 |
| 1679673685 | Manuela M Delacruz | Internal Medicine | 160 Kingsley Ln, Suite 103, Norfolk, VA 23505-4600 | 2006-09-22 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.