NPIMap

Organization Active NPI

Peninsula Institute for Community Health Inc

Doing business as Stoneybrook Physicians

  • Federally Qualified Health Center (FQHC)
  • Newport News, VA
National Provider Identifier
1275810152
Registry record updated Nov 7, 2011
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
Doing business as
Stoneybrook Physicians
Practice address
15425 Warwick Blvd # D
Newport News, VA 23608-1579
Phone
(757) 874-8400
Fax
(757) 874-2295
NPI assigned
Nov 7, 2011
Last updated
Nov 7, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2011

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

Authorized official

Name
Angela Futrell
Title
Executive Director
Phone
(757) 591-0643

Specialties & licenses 1

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

Addresses

Primary practice location

15425 Warwick Blvd # D
Newport News, VA 23608-1579

Mailing address

1033 28TH St
2ND Floor
Newport News, VA 23607-4233
Phone (757) 591-0643

Other names 1

  • Stoneybrook Physicians 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
O20120215000019 VA Part A Provider - Federally Qualified Health Center (FQHC) 9234040148 Practice locations: Newport News, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1275810152. Details of each certification follow.

Federally qualified health center certification: CCN 491913

Legal name
PENINSULA INSTITUTE FOR COMMUNITY HEALTH INC
Doing business as
STONEYBROOK PHYSICIANS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 15, 2012
Last certification
Feb 15, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 22, 1978 in VA
Enrollment address
15425 Warwick Blvd
# D
Newport News, VA 23608-1579

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

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Katherine Grant-Davis Individual Corporate DirectorMember Jun 25, 2015
Stylie Williams Individual Corporate Director Mar 31, 2016
April Burwell Individual Corporate Director Feb 17, 2022
Dorothy Murray Individual Corporate Director Aug 16, 2011
Shirley Wills Individual Corporate DirectorMember Apr 26, 2012
Asa Jenrette Individual Corporate DirectorMember Jun 25, 2015
Barrett Franklin Individual Corporate Director Oct 14, 2016
Yolanda Brannen Individual Corporate Director Feb 17, 2022
Angela Futrell Individual Corporate DirectorCeo Aug 16, 2011
W-2 Managing Employee May 1, 2008
Juan L Garcia Individual Corporate Director Feb 1, 2020
Caryl Johnson Individual Corporate Director Feb 17, 2022
Denise Counce Individual Corporate DirectorMember Mar 25, 2013
Wanda Allen Individual Corporate Director Aug 16, 2011
Aravia Johnson Individual Corporate DirectorMember Jun 25, 2015
Peninsula Institute for Community Health Inc Organization, Newport News, VA Corporation Operational/Managerial Control Aug 16, 2011
Ruth Holmes Individual Corporate Director Oct 14, 2016

Owners & managing parties with NPI records 13

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1320624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320624000000",
    "number": "1275810152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1033 28TH ST",
            "address_2": "2ND FLOOR",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236074233",
            "telephone_number": "757-591-0643",
            "fax_number": "757-874-2295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15425 WARWICK BLVD # D",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236081579",
            "telephone_number": "757-874-8400",
            "fax_number": "757-874-2295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA INSTITUTE FOR COMMUNITY HEALTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-07",
        "last_updated": "2011-11-07",
        "status": "A",
        "authorized_official_last_name": "FUTRELL",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "757-591-0643"
    },
    "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": "Stoneybrook Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newport News, VA

Sources for this page

Verify at the official NPI Registry.