NPIMap

Organization Active NPI

Peninsula Institute for Community Health Inc

Doing business as Warwick Boulevard Physicians

  • Federally Qualified Health Center (FQHC)
  • Newport News, VA
National Provider Identifier
1538725668
Registry record updated May 14, 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
Doing business as
Warwick Boulevard Physicians
Practice address
9294 Warwick Blvd
Newport News, VA 23607-1535
Phone
(757) 591-0643
NPI assigned
May 14, 2019
Last updated
May 14, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2019

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) 591-0643

Specialties & licenses 1

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

Addresses

Primary practice location

9294 Warwick Blvd
Newport News, VA 23607-1535

Mailing address

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

Other names 1

  • Warwick Boulevard 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
O20200903003774 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 1538725668. Details of each certification follow.

Federally qualified health center certification: CCN 491016

Legal name
PENINSULA INSTITUTE FOR COMMUNITY HEALTH INC
Doing business as
WARWICK BOULEVARD PHYSICIANS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 3, 2020
Last certification
Sep 3, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 22, 1978 in VA
Enrollment address
9294 Warwick Blvd
Newport News, VA 23607-1535

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
49D2169215Warwick Boulevard Physicians9294 Warwick Boulevard, Newport News, VA 23607Certificate of waiverJul 16, 2027

National Provider Directory

National Provider Directory
Tax ID family
Peninsla Inst-Com HLT Igrp8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

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 May 1, 2008
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 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 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1557792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557792000000",
    "number": "1538725668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1033 28TH ST FL 2",
            "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": "9294 WARWICK BLVD",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236071535",
            "telephone_number": "757-591-0643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA INSTITUTE FOR COMMUNITY HEALTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-14",
        "last_updated": "2019-05-14",
        "status": "A",
        "authorized_official_last_name": "FUTRELL",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "757-591-0643"
    },
    "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": "Warwick Boulevard Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newport News, VA

Sources for this page

Verify at the official NPI Registry.