NPIMap

Organization Active NPI

Peninsula Institute for Community Health Inc

Doing business as Burnetts Way Family Medicine

  • Federally Qualified Health Center (FQHC)
  • Suffolk, VA
National Provider Identifier
1790575116
Registry record updated Jun 2, 2025
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
Burnetts Way Family Medicine
Practice address
156 Burnetts Way
Suffolk, VA 23434-8166
Phone
(757) 380-8709
NPI assigned
May 8, 2025
Last updated
Jun 2, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2025

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

Authorized official

Name
Angela Futrell
Title
Chief Executive Officer
Phone
(757) 591-0643

Specialties & licenses 1

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

Addresses

Primary practice location

156 Burnetts Way
Suffolk, VA 23434-8166

Mailing address

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

Other names 1

  • Burnetts Way Family Medicine Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040611000280 VA Part B Supplier - Clinic/Group Practice 9234040148 Receives reassigned benefits from 19 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chesapeake, VA; Virginia Beach, VA; Suffolk, VA; Newport News, VA; Hampton, VA
O20251119000580 VA Part A Provider - Federally Qualified Health Center (FQHC) 9234040148 Practice locations: Suffolk, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790575116. Details of each certification follow.

Federally qualified health center certification: CCN 491043

Legal name
PENINSULA INSTITUTE FOR COMMUNITY HEALTH INC
Doing business as
BURNETTS WAY FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 18, 2025
Last certification
Nov 18, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
156 Burnetts Way
Suffolk, VA 23434-8166

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

Other NPIs on the same Medicare enrollment 13

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

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
49D0884606Burnetts Way Family Medicine156 Burnetts Way, Suffolk, VA 23434Certificate of waiverApr 5, 2028

National Provider Directory

National Provider Directory
Tax ID family
Peninsla Inst-Com HLT Igrp8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

490 Liberty St
Chesapeake, VA 23324
Phone (757) 228-1288

300 Medical Dr
Ste 400
Hampton, VA 23666
Phone (757) 788-0400

15425 Warwick Blvd
#D
Newport News, VA 23608
Phone (757) 874-8400

156 Burnetts Way
Suffolk, VA 23434
Phone (757) 934-6470

5268 Godwin Blvd
Suffolk, VA 23434
Phone (757) 255-7117

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Angela Futrell Individual Corporate DirectorCeo Jul 1, 2025
Kimberley M Allsbrook Individual W-2 Managing EmployeeCfo Jul 1, 2025

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 6

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": "1746662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748822400000",
    "number": "1790575116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1033 28TH ST",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236074233",
            "telephone_number": "757-591-0643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "156 BURNETTS WAY",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234348166",
            "telephone_number": "757-380-8709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA INSTITUTE FOR COMMUNITY HEALTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-08",
        "last_updated": "2025-06-02",
        "certification_date": "2025-06-02",
        "status": "A",
        "authorized_official_last_name": "FUTRELL",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "757-591-0643"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Burnetts Way Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Suffolk, VA

Sources for this page

Verify at the official NPI Registry.