NPIMap

Organization Active NPI

Eastern Shore Rural Health System Incorporated

  • Federally Qualified Health Center (FQHC)
  • New Church, VA
National Provider Identifier
1043341613
Registry record updated Mar 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
EASTERN SHORE RURAL HEALTH SYSTEM INCORPORATED
Practice address
5219 Lankford Hwy
New Church, VA 23415-3332
Phone
(757) 824-5676
Fax
(757) 824-5872
NPI assigned
Mar 8, 2007
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Jeannette Edwards
Title
Chief Executive Officer
Phone
(757) 414-0400

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Facilities connected through Provider of Services related, parent or unit certification numbers.

Practitioners 52

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 52

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D0228468Atlantic Community Health Center5219 Lankford Highway, New Church, VA 23415Provider-performed microscopyDec 22, 2027

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040122001049 VA Part B Supplier - Clinic/Group Practice 2668380106 Receives reassigned benefits from 50 practitioners
5 other NPIs on this enrollment
Practice locations: Onley, VA; New Church, VA; Franktown, VA; Eastville, VA; Chincoteague, VA
O20051108000502 VA Part a Provider - Federally Qualified Health Center (FQHC) 2668380106 Practice locations: New Church, VA

Federally qualified health center certification: CCN 491804

Medicare enrollment files
Legal name
EASTERN SHORE RURAL HEALTH SYSTEM INCORPORATED
Doing business as
ATLANTIC COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 16, 1976 in VA
Enrollment address
5219 Lankford Hwy
New Church, VA 23415-3332

All disclosed owners & managing parties 17

Medicare enrollment files

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Betty B Bibbins Individual Corporate OfficerVice President Mar 27, 2018
Luther M Byrd Individual Corporate Director Mar 21, 2017
Kandice Turlington Bruno Individual Corporate Director Jun 7, 2010
Arthur M Fournier Individual Corporate DirectorBoard Member Mar 28, 2023
John G Sparkman Individual Corporate Director Jun 27, 2017
John Davenport Individual Corporate DirectorBoard Member Mar 28, 2023
Doris Ebony Brown Individual Corporate DirectorBoard Member Nov 15, 2022
William a Cobb Individual Corporate Director Aug 31, 2021
Jeannette Edwards Individual Corporate OfficerChief Executive Officer Aug 28, 2000
W-2 Managing EmployeeChief Executive Officer Aug 28, 2000
Chad Saunders Individual Corporate DirectorDirector May 24, 2022
Lisa M Cuba Individual Corporate Director May 25, 2021
Michael Imperial Individual Corporate DirectorBoard Member Mar 28, 2023
Kristine Marcy Individual Corporate DirectorBoard Member Jun 1, 2024
Constance Johnson Individual Corporate DirectorDirector May 24, 2022
Leslie West Individual Corporate DirectorBoard Member Mar 28, 2023
Charles Lawrence Individual Corporate DirectorBoard Member Jun 1, 2024
Marisa R Sanchez Individual Corporate DirectorBoard Member Dec 19, 2023

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JIBEAA

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

NPPES NPI Registry

Primary practice location

5219 Lankford Hwy
New Church, VA 23415-3332

Mailing address

20280 Market St
Onancock, VA 23417-1331
Phone (757) 414-0401

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
007695187MedicaidVA

Other names 1

NPPES NPI Registry
  • Atlantic Community Health Center Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 22, 2023.

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679443200000",
    "number": "1043341613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20280 MARKET ST",
            "city": "ONANCOCK",
            "state": "VA",
            "postal_code": "234171331",
            "telephone_number": "757-414-0401",
            "fax_number": "757-414-0569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5219 LANKFORD HWY",
            "city": "NEW CHURCH",
            "state": "VA",
            "postal_code": "234153332",
            "telephone_number": "757-824-5676",
            "fax_number": "757-824-5872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN SHORE RURAL HEALTH SYSTEM INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2023-03-22",
        "certification_date": "2023-03-22",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "JEANNETTE",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "757-414-0400"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007695187",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Atlantic Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Atlantic Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New Church, VA

Sources for this page

Verify at the official NPI Registry.