NPIMap

Organization Active NPI

Peninsula Institute for Community Health Inc

  • Federally Qualified Health Center (FQHC)
  • Newport News, VA
National Provider Identifier
1093367732
Registry record updated Jul 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PENINSULA INSTITUTE FOR COMMUNITY HEALTH INC
Practice address
7401 Warwick Blvd
Newport News, VA 23607-1515
Phone
(757) 591-0643
NPI assigned
Jul 12, 2019
Organization subpart
Yes
Parent organization
PENINSULA INSTITUTE FOR COMMUNITY HEALTH INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 12, 2019

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

Authorized official

Name
Nona P Hilton
Title
Chief Financial Officer
Phone
(757) 591-0643

Specialties & licenses 1

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

Addresses

Primary practice location

7401 Warwick Blvd
Newport News, VA 23607-1515

Mailing address

1033 28TH St
Newport News, VA 23607-4233
Phone (757) 591-0643

Other names 2

  • SEVHS @ Four Oaks Day Services Center Doing business as
  • SEVHS@ Four Oaks Day Services 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
O20040611000280 VA Part B Supplier - Clinic/Group Practice 9234040148 Receives reassigned benefits from 19 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chesapeake, VA; Virginia Beach, VA; Suffolk, VA; Newport News, VA; Hampton, VA
O20200810003538 VA Part A Provider - Federally Qualified Health Center (FQHC) 9234040148 Practice locations: Newport News, VA

Federally qualified health center certification: CCN 491979

Legal name
PENINSULA INSTITUTE FOR COMMUNITY HEALTH INC
Doing business as
SEVHS@FOUR OAKS DAY SERVICES CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 30, 2020
Last certification
Jul 30, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 22, 1978 in VA
Enrollment address
7401 Warwick Blvd
Newport News, VA 23607-1515

Other NPIs with the same Medicare PAC ID 13

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

View all 13

Other NPIs on the same Medicare enrollment 13

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

View all 13

National Provider Directory

National Provider Directory
Tax ID family
Peninsla Inst-Com HLT I8 organizations share this tax ID, including this one
Part of
Peninsla Inst-Com HLT I

Other organizations with this tax ID 7

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

Locations

1357 Armory Dr
Franklin, VA 23851
Phone (757) 304-5570

157 N Main St
Ste A
Suffolk, VA 23434
Phone (757) 925-1866

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
Tiffany Bowen Individual Corporate OfficerSecretary Jun 23, 2016
Katherine Grant-Davis Individual Corporate Director Jun 25, 2015
Stylie Williams Individual Corporate OfficerParliamentarian Sep 1, 2016
Dorothy Murray Individual Corporate Director Sep 10, 2014
Shirley Wills Individual Corporate OfficerVice Chair Apr 26, 2012
Asa Jenrette Individual Corporate Director Jun 25, 2015
Barrett Franklin Individual Corporate Director Mar 1, 2019
Angela Futrell Individual W-2 Managing Employee Jan 5, 2009
Roze Merditaj Individual Corporate Director Sep 19, 2019
Robert Ayers Individual Corporate Director Feb 29, 2000
Denise Counce Individual Corporate OfficerTreasurer Sep 10, 2014
Wanda Allen Individual Corporate OfficerChair Jul 29, 1997
Aravia Johnson Individual Corporate Officer Jun 25, 2015
Ruth Holmes Individual Corporate Director Jan 1, 2018

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Stoneybrook PhysiciansNewport News, VA, CCN 491913 Federally qualified health center Operational/Managerial Control Aug 16, 2011

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1562889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562889600000",
    "number": "1093367732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1033 28TH ST",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236074233",
            "telephone_number": "757-591-0643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7401 WARWICK BLVD",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236071515",
            "telephone_number": "757-591-0643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA INSTITUTE FOR COMMUNITY HEALTH INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PENINSULA INSTITUTE FOR COMMUNITY HEALTH INC",
        "enumeration_date": "2019-07-12",
        "last_updated": "2019-07-12",
        "status": "A",
        "authorized_official_last_name": "HILTON",
        "authorized_official_first_name": "NONA",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "757-591-0643"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SEVHS @ Four Oaks Day Services Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SEVHS@ Four Oaks Day Services Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newport News, VA

Sources for this page

Verify at the official NPI Registry.