MEDICARE: BON SECOURS MEDICAL GROUP RICHMOND PRIMARY CARE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207RS0010X	Sports Medicine (Internal Medicine) Physician
2	174400000X	Specialist
3	208000000X	Pediatrics Physician
4	251E00000X	Home Health Agency
5	207R00000X	Internal Medicine Physician
6	207QG0300X	Geriatric Medicine (Family Medicine) Physician
7	261QP2300X	Primary Care Clinic/Center
8	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1861050635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BON SECOURS MEDICAL GROUP RICHMOND PRIMARY 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	:	06/05/2019
Last Update Date	:	03/11/2026

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