1. Home
  2. Directory
  3. Virginia
  4. Richmond
  5. Clinic Center
  6. NPI Profile

BON SECOURS SHORT PUMP PRIMARY CARE
NPI 1124532239
Clinic/Center - Primary Care in Richmond, VA

Active since November 28, 2017CLIA 49D2145741 · Waiver
12320 W BROAD ST STE 204, RICHMOND, VA 23233(804) 612-2980(804) 762-7102 Get Directions Write a Review

NPPES record last updated: August 30, 2019. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Aug 30, 2019, Oct 24, 2018, Jun 27, 2018 and 2 more (5 updates tracked since 2017).

About Bon Secours Short Pump Primary Care NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BON SECOURS SHORT PUMP PRIMARY CARE (NPI 1124532239) is a healthcare organization registered as a primary care in Richmond, Virginia and active in the NPI registry since November 2017. The organization holds a CLIA Waiver certificate valid through March 13, 2028 and lists Stephan Quiriconi, Cfo, as its authorized official.

NPPES Registry Identity

NPI1124532239
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameBON SECOURS-ST. MARY'S HOSPITAL OF RICHMOND, INC.
Location Address12320 W BROAD ST STE 204Richmond, VA 23233
Mailing Address8580 Magellan PkwyRichmond, VA 23227-1149 · Fax (866) 449-0896
Phone(804) 612-2980
Fax(804) 762-7102
Organization SubpartNo
Authorized OfficialStephan QuiriconiCfo · (804) 281-8301
Enumeration DateNovember 28, 2017
Last NPPES UpdateAugust 30, 20195 updates tracked since enumeration
✔ NPI 1124532239 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
12320 W BROAD ST STE 204, Richmond, VA 23233
Open in Google Maps ↗

Other Names 1

Doing Business AsBon Secours Short Pump Primary Care

Other Identifiers 1

OtherC06778VA · Medicare Ptan

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 49D2145741

Bon Secours Short Pump Primary Care · Richmond, VA
Active · expires Mar 13, 2028
CLIA Number49D2145741
Laboratory TypePhysician Office
Certificate Effective DateMarch 14, 2026
Certificate Expiration DateMarch 13, 2028
Laboratory DirectorAysha Habib
Laboratory Phone(804) 612-2980
Laboratory LocationBon Secours Short Pump Primary Care12320 West Broad Street, Ste 204, Richmond, VA 23233
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. PRAVIN DESHMUKH M.D.
Internal Medicine
12320 W BROAD ST STE 204
RICHMOND, VA 23233
Henrico County (804) 612-2980
MR. JOSEPH MICHAEL BELL RN
Nurse Practitioner (Family)
12320 W BROAD ST STE 204
RICHMOND, VA 23233
Henrico County (804) 612-2980
KRISTIN WHITNEY ANDERSON PA-C
Physician Assistant
12320 W BROAD ST STE 204
RICHMOND, VA 23233
Henrico County (804) 612-2980
WHITNEY WASHINGTON NURSE PRACTITIONER
Nurse Practitioner (Family)
12320 W BROAD ST STE 204
RICHMOND, VA 23233
Henrico County (804) 612-2980
DR. AYSHA HABIB MBBS
Internal Medicine
12320 W BROAD ST STE 204
HENRICO, VA 23233
Henrico County (804) 612-2980
BON SECOURS MERCY HEALTH VIRTUAL CARE LLC
Family Medicine
12320 W BROAD ST STE 204
HENRICO, VA 23233
Henrico County (513) 752-8000
JOSEPH F WOOD NP
Nurse Practitioner (Family)
12320 W BROAD ST STE 204
RICHMOND, VA 23233
Henrico County (804) 612-2980

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Bon Secours-St. Mary's Hospital Of Richmond, Inc.'s NPI number?

The NPI number for Bon Secours-St. Mary's Hospital Of Richmond, Inc. is 1124532239. It was assigned to this organization in the NPPES registry on November 28, 2017. The provider is doing business as Bon Secours Short Pump Primary Care.

Where is Bon Secours-St. Mary's Hospital Of Richmond, Inc. located?

Bon Secours-St. Mary's Hospital Of Richmond, Inc. is located at 12320 W Broad St Ste 204, Richmond, VA 23233. The listed phone number is (804) 612-2980.

What is Bon Secours-St. Mary's Hospital Of Richmond, Inc.'s specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Does Bon Secours-St. Mary's Hospital Of Richmond, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 49D2145741) is associated with this NPI, valid through March 13, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Bon Secours-St. Mary's Hospital Of Richmond, Inc. was last updated on August 30, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.