NPIMap

Organization Active NPI

Peninsula Regional Medical Center

  • Family Medicine Physician
  • Chincoteague, VA
National Provider Identifier
1003058629
Registry record updated Apr 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PENINSULA REGIONAL MEDICAL CENTER
Practice address
6295 Teal LN
Island Family Medicine
Chincoteague, VA 23336-2207
Phone
(757) 336-2200
Fax
(757) 336-2211
NPI assigned
Mar 27, 2009
Last updated
Apr 30, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Donna E Horner
Title
Credentialing Coordinator
Phone
(410) 543-7531

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

6295 Teal LN
Island Family Medicine
Chincoteague, VA 23336-2207

Mailing address

100 E Carroll St
Salisbury, MD 21801
Phone (410) 543-7252

Other names 1

  • Island Family Medicine Other name

National Provider Directory

National Provider Directory
Tax ID family
Peninsula General Hosp33 organizations share this tax ID, including this one

Other organizations with this tax ID 32

Organizations that report the same tax identification number in the National Provider Directory.

View all 32

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1238112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241049600000",
    "number": "1003058629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E CARROLL ST",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "21801",
            "telephone_number": "410-543-7252",
            "fax_number": "410-912-6386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6295 TEAL LN",
            "address_2": "ISLAND FAMILY MEDICINE",
            "city": "CHINCOTEAGUE",
            "state": "VA",
            "postal_code": "233362207",
            "telephone_number": "757-336-2200",
            "fax_number": "757-336-2211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-27",
        "last_updated": "2009-04-30",
        "status": "A",
        "authorized_official_last_name": "HORNER",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "410-543-7531"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Island Family Medicine",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Chincoteague, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.