MEDICARE: BON SECOURS MEDICAL GROUP HAMPTON ROADS SPECIALTY CARE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2084P0800X	Psychiatry Physician
2	208600000X	Surgery Physician
3	207VX0201X	Gynecologic Oncology Physician
4	207RX0202X	Medical Oncology Physician
5	363L00000X	Nurse Practitioner
6	207X00000X	Orthopaedic Surgery Physician
7	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
8	207RP1001X	Pulmonary Disease Physician
9	208VP0000X	Pain Medicine Physician
10	2085R0001X	Radiation Oncology Physician
11	367500000X	Certified Registered Nurse Anesthetist
12	207RG0100X	Gastroenterology Physician
13	2084N0400X	Neurology Physician
14	207V00000X	Obstetrics & Gynecology Physician
15	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1629637475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BON SECOURS MEDICAL GROUP HAMPTON ROADS 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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