NPIMap

Organization Active NPI

Peninsula Community Health Services

  • Federally Qualified Health Center (FQHC)
  • Port Orchard, WA
National Provider Identifier
1699573634
Registry record updated Mar 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PENINSULA COMMUNITY HEALTH SERVICES
Practice address
4459 SE Mile Hill Drive, RM Clinic
Port Orchard, WA 98366-3908
Phone
(360) 377-3776
NPI assigned
Mar 5, 2025
Last updated
Mar 5, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2025

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

Authorized official

Name
Mr. Bruce Brazier
Title
Administrative Services Director
Phone
(360) 475-6715

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

4459 SE Mile Hill Drive, RM Clinic
Port Orchard, WA 98366-3908

Mailing address

PO Box 960
Bremerton, WA 98337-0212
Phone (360) 377-3776

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250805000468 WA Part A Provider - Federally Qualified Health Center (FQHC) 9436044781 Practice locations: Port Orchard, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699573634. Details of each certification follow.

Federally qualified health center certification: CCN 501067

Legal name
PENINSULA COMMUNITY HEALTH SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 15, 2025
Last certification
Jul 15, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
4459 SE Mile Hill Drive, RM Clinic
Port Orchard, WA 98366

National Provider Directory

National Provider Directory
Tax ID family
Peninsula Comm HLTH Service50 organizations share this tax ID, including this one

Other organizations with this tax ID 49

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

View all 49

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Christopher J Cook Individual Corporate Director Jan 1, 2018
Jennifer Kreidler-Moss Individual Corporate OfficerCeo Jun 1, 2016 100%
W-2 Managing EmployeeCeo Jun 1, 2016
Operational/Managerial ControlCeo Jun 1, 2016 100%
Susan Astle Individual Corporate Director Jan 1, 2018
Monica Bernhard Individual Corporate Director Jan 1, 2018
Yolanda N Fong Individual Corporate Director Sep 18, 2024
Neal Schanbeck Individual Corporate DirectorCommunity Member Dec 17, 2025
Lolita Afalla Individual Corporate Director Sep 18, 2024
Leslie Jackson Individual Corporate DirectorPatient Member Nov 19, 2025
Mary Berglind Individual Corporate Director Feb 1, 2023
Kristin Lillegard Individual Corporate DirectorCommunity Member Feb 18, 2026
Alfred D Pinkham Individual Corporate Director Jan 1, 2018
Mary Dixon Individual Corporate DirectorPatient Member Aug 20, 2025
David Windom Individual Corporate Director Feb 1, 2022
Peninsula Community Health Services Organization, Bremerton, WA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Feb 5, 2025
Rogelio Valencia Individual Corporate Officer Feb 1, 2022
Shannon Turner Individual Corporate Director May 21, 2025

All facility ownership & control disclosures 26

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Kitsap Community Health CentersPort Orchard, WA, CCN 501923 Federally qualified health center Operational/Managerial Control Jan 1, 2016
Peninsula Community Health ServicesBremerton, WA, CCN 501924 Federally qualified health center Operational/Managerial Control Jan 1, 2016
Peninsula Community Health ServicesBremerton, WA, CCN 941011 Federally qualified health center Operational/Managerial Control Jan 1, 2016
Peninsula Community Health Services BelfairBelfair, WA, CCN 941032 Federally qualified health center Operational/Managerial Control Apr 1, 2017
Peninsula Community Health Services KingstonKingston, WA, CCN 941033 Federally qualified health center Operational/Managerial Control May 1, 2017
Peninsula Community Health ServicesShelton, WA, CCN 941044 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2019
Peninsula Community Health ServicesBremerton, WA, CCN 941061 Federally qualified health center Operational/Managerial Control Sep 3, 2019
Peninsula Community Health ServicesBremerton, WA, CCN 941059 Federally qualified health center Operational/Managerial Control Sep 3, 2019
Peninsula Community Health ServicesBelfair, WA, CCN 941060 Federally qualified health center Operational/Managerial Control (100%) Sep 3, 2019
Peninsula Community Health ServicesBremerton, WA, CCN 941064 Federally qualified health center Operational/Managerial Control (100%) Sep 3, 2019
Peninsula Community Health ServicesSilverdale, WA, CCN 941070 Federally qualified health center Operational/Managerial Control May 1, 2020
Peninsula Community Health ServicesBremerton, WA, CCN 941074 Federally qualified health center Operational/Managerial Control (100%) Apr 20, 2020
Peninsula Community Health ServicesGig Harbor, WA, CCN 501005 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Nov 17, 2021
Nov 17, 2021
Peninsula Community Health ServicesBremerton, WA, CCN 501006 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 31, 2022
May 31, 2022
Peninsula Community Health ServicesBremerton, WA, CCN 501010 Federally qualified health center 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Sep 16, 2022
Sep 16, 2022
Peninsula Community Health ServicesPort Orchard, WA, CCN 501007 Federally qualified health center 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Sep 24, 2021
Sep 24, 2021
Peninsula Community Health ServicesBremerton, WA, CCN 501008 Federally qualified health center 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Oct 1, 2021
Oct 1, 2021
Peninsula Community Health ServicesKingston, WA, CCN 501013 Federally qualified health center 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Apr 14, 2022
Apr 14, 2022
Peninsula Community Health ServicesBremerton, WA, CCN 501012 Federally qualified health center 5% Or Greater Direct Ownership Interest Apr 14, 2022
Peninsula Community Health ServicesBremerton, WA, CCN 501016 Federally qualified health center 5% Or Greater Direct Ownership Interest Aug 23, 2022
Peninsula Community Health ServicesSilverdale, WA, CCN 501015 Federally qualified health center 5% Or Greater Direct Ownership Interest Sep 24, 2021
Peninsula Community Health ServicesSilverdale, WA, CCN 501037 Federally qualified health center 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Sep 8, 2023
Sep 8, 2023
Peninsula Community Health ServicesSilverdale, WA, CCN 501035 Federally qualified health center 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Sep 8, 2023
Sep 8, 2023
Peninsula Community Health ServicesPoulsbo, WA, CCN 501038 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Nov 1, 2023
Nov 1, 2023
Peninsula Community Health ServicesPoulsbo, WA, CCN 501068 Federally qualified health center 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jun 1, 2025
Jun 1, 2025
Peninsula Community Health ServicesBainbridge Island, WA, CCN 501079 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 12, 2026
Jan 12, 2026

Facilities with the same owner 26

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1741132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741132800000",
    "number": "1699573634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 960",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983370212",
            "telephone_number": "360-377-3776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4459 SE MILE HILL DRIVE, RM CLINIC",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "983663908",
            "telephone_number": "360-377-3776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA COMMUNITY HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-05",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-04",
        "status": "A",
        "authorized_official_last_name": "BRAZIER",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "ADMINISTRATIVE SERVICES DIRECTOR",
        "authorized_official_telephone_number": "360-475-6715",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orchard, WA

Sources for this page

Verify at the official NPI Registry.