NPIMap

Organization Active NPI

Peninsula Institute for Community Health Inc

Doing business as Franklin Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Franklin, VA
National Provider Identifier
1750749818
Registry record updated Oct 18, 2016
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
Franklin Community Health Center
Practice address
1357 Armory Dr
Franklin, VA 23851-2419
Phone
(757) 304-5570
Fax
(757) 304-5577
NPI assigned
Feb 4, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2016

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

Authorized official

Name
Angela Futrell
Title
Ceo
Phone
(757) 591-0643

Specialties & licenses 1

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

Addresses

Primary practice location

1357 Armory Dr
Franklin, VA 23851-2419

Mailing address

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

Other names 1

  • Franklin 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
O20160714002354 VA Part A Provider - Federally Qualified Health Center (FQHC) 9234040148 Practice locations: Franklin, VA
O20161201001276 VA Part B Supplier - Clinic/Group Practice 9234040148 Receives reassigned benefits from 7 practitioners
Practice locations: Franklin, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1750749818. Details of each certification follow.

Federally qualified health center certification: CCN 491947

Legal name
PENINSULA INSTITUTE FOR COMMUNITY HEALTH INC
Doing business as
FRANKLIN COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 16, 2016
Last certification
May 16, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 22, 1978 in VA
Enrollment address
1357 Armory Dr
Franklin, VA 23851-2419

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

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
49D2109593Franklin Community Health Center1357 Armory Drive, Franklin, VA 23851Certificate of waiverFeb 28, 2028

National Provider Directory

National Provider Directory

Locations

1357 Armory Dr
Franklin, VA 23851
Phone (757) 304-5570

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Katherine Grant-Davis Individual Corporate DirectorDirector Jun 25, 2015
Dorothy Murray Individual Corporate DirectorVice Chair Mar 31, 1990
Shirley Wills Individual Corporate DirectorDirector Apr 26, 2012
Asa Jenrette Individual Corporate DirectorDirector Jun 25, 2015
Angela Futrell Individual Corporate DirectorCeo May 1, 2008
W-2 Managing EmployeeCeo May 1, 2008
Melinda Williams Individual Corporate DirectorTreasurer Feb 20, 2013
Robert Ayers Individual Corporate DirectorSecretary Feb 29, 2000
Denise Counce Individual Corporate DirectorDirector Mar 25, 2016
Wanda Allen Individual Corporate DirectorChair Jul 29, 1997
Aravia Johnson Individual Corporate DirectorDirector Jun 25, 2015
Barbara Easter Individual Corporate DirectorDirector May 31, 2012
Eugene Walden Johnson Individual Corporate DirectorParliamentarian Jul 26, 1990

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 7

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": "1454544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476748800000",
    "number": "1750749818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1033 28TH ST",
            "address_2": "2ND FLOOR",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236074233",
            "telephone_number": "757-591-0643",
            "fax_number": "757-228-1045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1357 ARMORY DR",
            "city": "FRANKLIN",
            "state": "VA",
            "postal_code": "238512419",
            "telephone_number": "757-304-5570",
            "fax_number": "757-304-5577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA INSTITUTE FOR COMMUNITY HEALTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-04",
        "last_updated": "2016-10-18",
        "status": "A",
        "authorized_official_last_name": "FUTRELL",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "757-591-0643"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Franklin Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Franklin, VA

Sources for this page

Verify at the official NPI Registry.