NPIMap

Organization Active NPI

Peninsula Institute for Community Health Inc

  • Federally Qualified Health Center (FQHC)
  • Newport News, VA
National Provider Identifier
1508999293
Registry record updated Apr 1, 2008
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
4714 Marshall Avenue
Newport News, VA 23607
Phone
(757) 380-8709
Fax
(757) 928-0902
NPI assigned
Mar 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2008

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

Authorized official

Name
Angela Futrell
Title
Chief Executive Officer
Phone
(757) 380-8709

Specialties & licenses 1

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

Addresses

Primary practice location

4714 Marshall Avenue
Newport News, VA 23607

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
7687648MedicaidVA

Other names 1

  • 48th Street 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
O20030715000005 VA Part A Provider - Federally Qualified Health Center (FQHC) 9234040148 Practice locations: Newport News, VA
O20040611000280 VA Part B Supplier - Clinic/Group Practice 9234040148 Receives reassigned benefits from 19 practitioners
13 other NPIs on this enrollment
Practice locations: Chesapeake, VA; Virginia Beach, VA; Suffolk, VA; Newport News, VA; Hampton, VA

Federally qualified health center certification: CCN 491818

Legal name
PENINSULA INSTITUTE FOR COMMUNITY HEALTH INC
Doing business as
48TH STREET PHYSICIANS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 15, 2003 in VA
Enrollment address
4714 Marshall Ave
Newport News, VA 23607-2247

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

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
49D023024448TH Street Physicians4714 Marshall Ave, Newport News, VA 23607Certificate of waiverJan 24, 2027

National Provider Directory

National Provider Directory

Locations

4714 Marshall Ave
Newport News, VA 23607
Phone (757) 380-8709

1033 28th St
Fl 2
Newport News, VA 23607
Phone (757) 591-0643

Ownership & related parties

All disclosed owners & managing parties 15

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 Director Jun 25, 2015
Stylie Williams Individual Corporate Director Sep 1, 2016
April Burwell Individual Corporate Director Feb 17, 2022
Dorothy Murray Individual Corporate Director Jun 14, 2010
Shirley Wills Individual Corporate OfficerChair Feb 1, 2021
Corporate Director Apr 26, 2012
Asa Jenrette Individual Corporate Director Jun 25, 2015
Barrett Franklin Individual Corporate Director Mar 1, 2019
Yolanda Brannen Individual Corporate Director Feb 17, 2022
Angela Futrell Individual Corporate DirectorCeo May 5, 2008
W-2 Managing EmployeeCeo May 5, 2008
Juan L Garcia Individual Corporate Director Feb 1, 2020
Caryl Johnson Individual Corporate Director Feb 17, 2022
Denise Counce Individual Corporate OfficerTreasurer Sep 10, 2014
Wanda Allen Individual Corporate Director Jun 14, 2010
Aravia Johnson Individual Corporate OfficerVice Chair Feb 1, 2021
Corporate Director 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 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207008000000",
    "number": "1508999293",
    "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": "757-591-0682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4714 MARSHALL AVENUE",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "23607",
            "telephone_number": "757-380-8709",
            "fax_number": "757-928-0902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA INSTITUTE FOR COMMUNITY HEALTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2008-04-01",
        "status": "A",
        "authorized_official_last_name": "FUTRELL",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "757-380-8709"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7687648",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "48th Street Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newport News, VA

Sources for this page

Verify at the official NPI Registry.