NPIMap

Organization Active NPI

Portsmouth Community Health Center, Inc

Doing business as Park Place Medical Center

  • Federally Qualified Health Center (FQHC)
  • Norfolk, VA
National Provider Identifier
1073833760
Registry record updated Nov 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PORTSMOUTH COMMUNITY HEALTH CENTER, INC
Doing business as
Park Place Medical Center
Practice address
155 Kingsley LN Ste 320
Norfolk, VA 23505-4629
Phone
(757) 533-9108
Fax
(757) 622-6384
NPI assigned
Jun 4, 2010
Last updated
Nov 26, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2025

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

Authorized official

Name
Michel Bile
Title
Ceo
Phone
(757) 681-2694

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

155 Kingsley LN Ste 320
Norfolk, VA 23505-4629

Mailing address

1541 High St
Portsmouth, VA 23704-3209
Phone (757) 393-6363

Other names 1

  • Park Place Medical Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040513001366 VA Part B Supplier - Clinic/Group Practice 1052301835 Receives reassigned benefits from 22 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Portsmouth, VA; Norfolk, VA
O20100625000483 VA Part A Provider - Federally Qualified Health Center (FQHC) 1052301835 Practice locations: Norfolk, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073833760. Details of each certification follow.

Federally qualified health center certification: CCN 491904

Legal name
PORTSMOUTH COMMUNITY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 20, 2010
Last certification
Oct 20, 2010
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 15, 1992 in VA
Enrollment address
155 Kingsley LN
Ste 320
Norfolk, VA 23505-4629

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 3

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

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
49D0999254Park Place Medical Center155 Kingsley Lane, Suite 320, Norfolk, VA 23505Provider-performed microscopyMay 7, 2028

National Provider Directory

National Provider Directory
Tax ID family
Evms Academic Phys and Surg8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Khara Jones Individual Corporate DirectorMember Feb 1, 2018
Paul D Chidester Individual Corporate DirectorSecretary May 29, 2012
Delores Adams Individual Corporate DirectorConsumer May 9, 2009
Dianne a Gardner Individual Corporate DirectorMember Feb 23, 2011
Tracey Davis Individual Corporate DirectorChairperson May 9, 2012
Meera Phaltankar Individual Corporate DirectorConsumer May 28, 2010
Mary Gore Individual Corporate DirectorMember May 26, 2010
Pricilla Eison Individual Corporate DirectorVice Chair May 28, 2008
Virginia Hankins Individual Corporate Director Dec 1, 2015
James K Bordner Individual W-2 Managing EmployeeDirector of Human Resources Nov 16, 2007
Dirkland Smith Individual Corporate DirectorMember Jul 18, 2012
Michel Bile Individual Contracted Managing EmployeeCeo Oct 23, 2024
Corporate DirectorCeo Oct 23, 2024
W-2 Managing EmployeeCeo Oct 23, 2024
Operational/Managerial ControlCeo Oct 23, 2024
Stephen Williams Individual Corporate DirectorMember May 28, 2008
Allson L Wittkamp Individual Corporate DirectorTreasurer May 23, 2007

Practitioners & affiliated clinicians

Practitioners 7

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": "1275609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764115200000",
    "number": "1073833760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1541 HIGH ST",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237043209",
            "telephone_number": "757-393-6363",
            "fax_number": "757-622-6384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 KINGSLEY LN STE 320",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235054629",
            "telephone_number": "757-533-9108",
            "fax_number": "757-622-6384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTSMOUTH COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-04",
        "last_updated": "2025-11-26",
        "certification_date": "2025-11-26",
        "status": "A",
        "authorized_official_last_name": "BILE",
        "authorized_official_first_name": "MICHEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "757-681-2694"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Place Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Park Place Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Norfolk, VA

Sources for this page

Verify at the official NPI Registry.