Peninsula ASC, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

PENINSULA ASC, LLC

Practice address

580 City Center Blvd
Newport News, VA 23606-1880

Phone

(757) 596-1900

NPI assigned

Apr 16, 2025

Organization subpart

No

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

Authorized official

Name

Kimberly M Ralston

Title

VP Reimbursement

Phone

(419) 996-5119

Specialties & licenses 1

Addresses

Other names 1

• Coastal Virginia Surgery Center Doing business as

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Orthopaedic Surgery and Sports Medicine Specialists

  • Magnetic Resonance Imaging (MRI) Clinic/Center
  • Newport News, VA
  • NPI 1700190170

  Member Of

  NPD member

Locations

Practitioners 2

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

• Racquel T Fung, NP

  • Family Nurse Practitioner
  • Newport News, VA
  • NPI 1811545510
  NPD (past)
• Jordan Marie Mears, NP

  • Family Medicine Physician
  • Virginia Beach, VA
  • NPI 1437847811
  NPD (past)

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

{
    "created_epoch": "1744761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744761600000",
    "number": "1447046586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "580 CITY CENTER BLVD",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236061880",
            "telephone_number": "757-596-1900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 CITY CENTER BLVD",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236061880",
            "telephone_number": "757-596-1900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA ASC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-16",
        "last_updated": "2025-04-16",
        "certification_date": "2025-04-16",
        "status": "A",
        "authorized_official_last_name": "RALSTON",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "VP REIMBURSEMENT",
        "authorized_official_telephone_number": "419-996-5119"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Virginia Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sharon L Pemberton, FNP-BC
• Pen Transport LLC
• Bayley Pendleton, ATC
• Peninsula Academy for Autism
• Peninsula Agency on Aging
• Peninsula Cancer Institute, LLC
• Peninsula Community Solutions
• Peninsula Counseling Center of Virginia, LLC
• Peninsula Dermatology Skin Cancer Surgery Center, Inc
• Peninsula Family Dentistry

• Ambulatory Surgical Clinic/Center in Newport News, VA
• Providers in Newport News, VA by specialty
• Ambulatory Surgical Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2025; 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.

Verify at the official NPI Registry.