NPIMap

Organization Active NPI

Eastern Shore Rural Health System Incorporated

Doing business as Chincoteague Island Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Chincoteague, VA
National Provider Identifier
1598895542
Registry record updated Feb 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
EASTERN SHORE RURAL HEALTH SYSTEM INCORPORATED
Doing business as
Chincoteague Island Community Health Center
Practice address
4049 Main St
Chincoteague, VA 23336-2406
Phone
(757) 336-3682
Fax
(757) 336-3703
NPI assigned
Mar 7, 2007
Last updated
Feb 22, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2023

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

Authorized official

Name
Jeannette Edwards
Title
Chief Executive Officer
Phone
(757) 414-0400

Specialties & licenses 1

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

Addresses

Primary practice location

4049 Main St
Chincoteague, VA 23336-2406

Mailing address

20280 Market St
Onancock, VA 23417-1331
Phone (757) 414-0400

Other identifiers 1

IdentifierTypeStateIssuer
007604378MedicaidVA

Other names 1

  • Chincoteague Island Community Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20021029000032 VA Part A Provider - Federally Qualified Health Center (FQHC) 2668380106 Practice locations: Chincoteague Island, VA
O20040122001049 VA Part B Supplier - Clinic/Group Practice 2668380106 Receives reassigned benefits from 50 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Onley, VA; New Church, VA; Franktown, VA; Eastville, VA; Chincoteague, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1598895542. Details of each certification follow.

Federally qualified health center certification: CCN 491848

Legal name
EASTERN SHORE RURAL HEALTH SYSTEM INCORPORATED
Doing business as
CHINCOTEAGUE ISLAND COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 11, 2002
Last certification
Dec 11, 2002
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jul 16, 1976 in VA
Enrollment address
4049 Main St
Chincoteague Island, VA 23336-2406
Related CCNs
491804

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
49D1006365Chincoteague Island Community Health Center4049 Main Street, Chincoteague Island, VA 23336Provider-performed microscopyNov 13, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Betty B Bibbins Individual Corporate DirectorBoard Member Mar 27, 2018
Luther M Byrd Individual Corporate DirectorBoard Member Apr 25, 2017
Kandice Turlington Bruno Individual Corporate OfficerChief Financial Officer Jun 6, 1994
W-2 Managing EmployeeChief Financial Officer Jun 6, 1994
Arthur M Fournier Individual Corporate DirectorBoard Member Mar 28, 2023
John G Sparkman Individual Corporate DirectorBoard Member Jun 27, 2017
John Davenport Individual Corporate DirectorBoard Member Mar 28, 2023
Doris Ebony Brown Individual Corporate DirectorBoard Member Nov 15, 2022
William a Cobb Individual Corporate Director Aug 31, 2021
Jeannette Edwards Individual Corporate OfficerChief Executive Officer Aug 28, 2000
W-2 Managing EmployeeChief Executive Officer Aug 28, 2000
Chad Saunders Individual Corporate DirectorBoard Member May 24, 2022
Lisa M Cuba Individual Corporate Director May 25, 2021
Michael Imperial Individual Corporate DirectorBoard Member Mar 28, 2023
Kristine Marcy Individual Corporate DirectorBoard Member Jun 1, 2024
Constance Johnson Individual Corporate DirectorDirector May 24, 2022
Leslie West Individual Corporate DirectorBoard Member Mar 28, 2023
Charles Lawrence Individual Corporate DirectorBoard Member Jun 1, 2024
Marisa R Sanchez Individual Corporate DirectorBoard Member Dec 19, 2023

Practitioners & affiliated clinicians

Practitioners 40

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.

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677024000000",
    "number": "1598895542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20280 MARKET ST",
            "city": "ONANCOCK",
            "state": "VA",
            "postal_code": "234171331",
            "telephone_number": "757-414-0400",
            "fax_number": "757-414-0569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4049 MAIN ST",
            "city": "CHINCOTEAGUE",
            "state": "VA",
            "postal_code": "233362406",
            "telephone_number": "757-336-3682",
            "fax_number": "757-336-3703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN SHORE RURAL HEALTH SYSTEM INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2023-02-22",
        "certification_date": "2023-02-22",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "JEANNETTE",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "757-414-0400"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007604378",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chincoteague Island Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Chincoteague Island Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chincoteague, VA

Sources for this page

Verify at the official NPI Registry.