NPIMap

Organization Active NPI

Peninsula Cancer Institute LLC

Doing business as Shore Cancer Institute

  • Hematology & Oncology Physician
  • Onancock, VA
National Provider Identifier
1710218664
Registry record updated Feb 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
Legal business name
PENINSULA CANCER INSTITUTE LLC
Doing business as
Shore Cancer Institute
Practice address
20480 Market Street
Onancock, VA 23417
Phone
(757) 302-2600
NPI assigned
Jan 15, 2010
Last updated
Feb 9, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
RIVERSIDE HEALTHCARE ASSOCIATESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 9, 2017

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

Authorized official

Name
Braden Miller
Title
Cfo
Phone
(757) 316-5800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X NU Primary

Addresses

Primary practice location

20480 Market Street
Onancock, VA 23417

Mailing address

856 J Clyde Morris Blvd
Ste a
Newport News, VA 23601-1318
Phone (757) 316-5960

Other names 1

  • Shore Cancer Institute Doing business as

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
49D1038524Riverside Shore Cancer Institute20480 Market Street, Onancock, VA 23417Certificate of waiverMar 21, 2027

National Provider Directory

National Provider Directory
Tax ID family
Peninsula Cancer Institute LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Practitioners & affiliated clinicians

Practitioners 26

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 26

NPI Registry JSON

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

{
    "created_epoch": "1263513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486598400000",
    "number": "1710218664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "856 J CLYDE MORRIS BLVD",
            "address_2": "STE A",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236011318",
            "telephone_number": "757-316-5960",
            "fax_number": "757-534-5190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20480 MARKET STREET",
            "city": "ONANCOCK",
            "state": "VA",
            "postal_code": "23417",
            "telephone_number": "757-302-2600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA CANCER INSTITUTE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RIVERSIDE HEALTHCARE ASSOCIATES",
        "enumeration_date": "2010-01-15",
        "last_updated": "2017-02-09",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "BRADEN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "757-316-5800"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shore Cancer Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Onancock, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.