Peninsula Plastic Surgery Center

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

PENINSULA PLASTIC SURGERY CENTER

Practice address

324 Monticello Ave
Williamsburg, VA 23185-2834

Phone

(757) 229-5200

Fax

(757) 229-2692

NPI assigned

Jan 3, 2007

Organization subpart

No

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

Authorized official

Name

Dr. John M. Pitman III, M.D.

Title

Physician

Phone

(757) 229-5200

Specialties & licenses 4

Addresses

Other identifiers 8

Practitioners 1

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

• Krystal Allbritton, PA

  • Physician Assistant
  • San Antonio, TX
  • NPI 1245425305
  NPD (past)

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607644800000",
    "number": "1689731986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 MONTICELLO AVE",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231852834",
            "telephone_number": "757-229-5200",
            "fax_number": "757-229-2692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 MONTICELLO AVE",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231852834",
            "telephone_number": "757-229-5200",
            "fax_number": "757-229-2692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA PLASTIC SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2020-12-11",
        "certification_date": "2020-12-11",
        "status": "A",
        "authorized_official_last_name": "PITMAN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "757-229-5200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "VA",
            "license": "0101052484",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2082S0105X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery, Surgery of the Hand",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "140457",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "213427",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOUTHERN HEALTH",
            "identifier": "121242",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "620043172",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "432612",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5209080",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007601328",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SENTARA OPTIMA",
            "identifier": "54536",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Bowles Pender
• Shane H Peng, M.D.
• Peninsula Anesthesia Consultants LLC
• Peninsula Dermatology Skin Cancer Surgery Center, Inc
• Peninsula Plastic Surgery Center
• Peninsula Plastic Surgery Center-ASC
• Peninsula Psychotherapy Center
• Peninsula Surgery Center II LLC
• Pentus Health Primary Care WB LLC
• Andres Peralta, FNP-C

• General Practice Physician in Williamsburg, VA
• Providers in Williamsburg, VA by specialty
• General Practice Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.