BON SECOURS SHORT PUMP PRIMARY CARE
NPI 1124532239
Clinic/Center - Primary Care in Richmond, VA
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
Specialties & Licenses
Other Names 1
Other Identifiers 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Bon Secours Short Pump Primary Care is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
163Medicare enrollment records show 163 clinicians reassign Medicare billing to Bon Secours Short Pump Primary Care, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 67 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 24
Nearest to this location (20)
See all 163Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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, VAFrequently 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.
Is Bon Secours-St. Mary's Hospital Of Richmond, Inc. enrolled in Medicare?
Yes. Bon Secours-St. Mary's Hospital Of Richmond, Inc. is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Bon Secours-St. Mary's Hospital Of Richmond, Inc.?
According to the CMS Revalidation Reassignment List (October 2026 release), 163 clinicians in 24 Medicare specialties reassign their Medicare billing to Bon Secours-St. Mary's Hospital Of Richmond, Inc.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (46), Internal Medicine (25) and Obstetrics/Gynecology (23). Of these, 1 practice at this address and 67 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 7 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.
# Bon Secours Short Pump Primary Care · NPI 1124532239
Primary Care organization in Richmond, Virginia. Organization record, active in the CMS NPPES registry since November 28, 2017.
## Identity
- **NPI:** 1124532239 (Entity type: Organization)
- **Enumerated:** November 28, 2017
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Legal business name:** Bon Secours-St. Mary's Hospital Of Richmond, Inc.
- **Organization subpart:** No
- **Authorized official:** Stephan Quiriconi, CFO
## Practice location
- **Address:** 12320 W BROAD ST STE 204, Richmond, VA 23233
- **Phone:** (804) 612-2980 · **Fax:** (804) 762-7102
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 163 clinicians in 24 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (46), Internal Medicine (25), Obstetrics/Gynecology (23); 1 practice at this address and 67 within 10 miles; [full list](https://npiprofile.com/npi/1124532239/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 30, 2019
- **Other identifiers:** Other C06778 (VA)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1124532239) · Data from the CMS NPPES public registry.