MEDICARE: BON SECOURS MEDICAL GROUP RICHMOND SPECIALTY CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	2080P0214X	Pediatric Pulmonology Physician
2	207N00000X	Dermatology Physician
3	208000000X	Pediatrics Physician
4	2080P0008X	Pediatric Neurodevelopmental Disabilities Physician
5	207RE0101X	Endocrinology, Diabetes & Metabolism Physician
6	2080P0207X	Pediatric Hematology & Oncology Physician
7	207RS0012X	Sleep Medicine (Internal Medicine) Physician
8	207V00000X	Obstetrics & Gynecology Physician
9	208600000X	Surgery Physician
10	2084P0800X	Psychiatry Physician
11	207X00000X	Orthopaedic Surgery Physician
12	103T00000X	Psychologist
13	207RG0300X	Geriatric Medicine (Internal Medicine) Physician
14	2084N0400X	Neurology Physician
15	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1477112225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BON SECOURS MEDICAL GROUP RICHMOND SPECIALTY CARE LLC

Provider Business Mailing Address
First Line	:	4600 MCAULEY PL STE 600
Second Line	:
City	:	BLUE ASH
State	:	OH
Zip	:	45242-4778
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8580 MAGELLAN PKWY
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-1149
Country	:	US
Telephone Number	:	804-627-5573
Fax Number	:	866-449-0896

Authorized Official
Title or Position	:	SYSTEM DIRECTOR, PAYER DELEGATION &
Name	:	CASSIE LOWE
Credential	:
Telephone Number	:	513-952-5210

Provider Enumeration Date	:	06/06/2019
Last Update Date	:	03/11/2026

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