Active NPI
Riverside Physician Services Inc
Doing business as Peninsula Surgical
- Surgery Physician
- Newport News, VA
National Provider Identifier
1205997780
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- Legal business name
- RIVERSIDE PHYSICIAN SERVICES INC
- Doing business as
- Peninsula Surgical
- Practice address
- 500 J Clyde Morris Blvd
Suite 601
Newport News, VA 23601-1929 - Phone
- (757) 534-5300
- Fax
- (757) 532-5316
- NPI assigned
- Dec 12, 2006
- Last updated
- Oct 31, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Michael J Doucette
- Title
- Vice President
- Phone
- (757) 594-4006
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | Primary |
Addresses
Primary practice location
500 J Clyde Morris Blvd
Suite 601
Newport News, VA 23601-1929
Mailing address
856 J Clyde Morris Blvd
Suite a
Newport News, VA 23601-1318
Phone (757) 594-4006
Other names 1
- Peninsula Surgical
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040207000400 | VA | Part B Supplier - Clinic/Group Practice | 5092608448 |
Receives reassigned benefits from 1,191 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165881600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1225411200000",
"number": "1205997780",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "856 J CLYDE MORRIS BLVD",
"address_2": "SUITE A",
"city": "NEWPORT NEWS",
"state": "VA",
"postal_code": "236011318",
"telephone_number": "757-594-4006",
"fax_number": "757-594-2195"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 J CLYDE MORRIS BLVD",
"address_2": "SUITE 601",
"city": "NEWPORT NEWS",
"state": "VA",
"postal_code": "236011929",
"telephone_number": "757-534-5300",
"fax_number": "757-532-5316"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "RIVERSIDE PHYSICIAN SERVICES INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-12-12",
"last_updated": "2008-10-31",
"status": "A",
"authorized_official_last_name": "DOUCETTE",
"authorized_official_first_name": "MICHAEL",
"authorized_official_middle_name": "J",
"authorized_official_title_or_position": "VICE PRESIDENT",
"authorized_official_telephone_number": "757-594-4006"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Peninsula Surgical",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Newport News, VA
- Riverside Physician Services Inc (Riverside Hampton Roads Neurosurgical & Spine Specialists)
- Riverside Physician Services Inc (Riverside Neurology Specialists - ACL)
- Riverside Physician Services Inc (Drs Wetchler and Dineen)
- Riverside Physician Services Inc (Riverside Urogynecology Specialists Newport News)
- Riverside Physician Services Inc (Riverside Gastroenterology Specialists)
- Riverside Physician Services Inc (Hampton Roads Eye Associates-Oyster Point)
- Riverside Physician Services Inc (Riverside Infectious Disease Specialists)
- Riverside Physician Services Inc (Riverside Neuropsychology and Behavioral Medicine)
- Riverside Physician Services Inc (Riverside Orthopedic, Sports Medicine & Physiatry Specialists)
- Riverside Physician Services Inc (Riverside Endocrinology & Diabetes Specialists)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.