NPIMap

Organization Active NPI

Peninsula Institute for Community Health Inc

Doing business as Virginia Beach Family Medicine

  • Federally Qualified Health Center (FQHC)
  • Virginia Beach, VA
National Provider Identifier
1902050875
Registry record updated Mar 30, 2009
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
Virginia Beach Family Medicine
Practice address
940 General Booth Blvd
Suite a
Virginia Beach, VA 23451-4857
Phone
(757) 591-0643
Fax
(757) 928-3239
NPI assigned
Nov 5, 2008
Last updated
Mar 30, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2009

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

940 General Booth Blvd
Suite a
Virginia Beach, VA 23451-4857

Mailing address

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

Other names 1

  • Virginia Beach 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
O20090204000452 VA Part A Provider - Federally Qualified Health Center (FQHC) 9234040148 Practice locations: Virginia Beach, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902050875. Details of each certification follow.

Federally qualified health center certification: CCN 491893

Legal name
PENINSULA INSTITUTE FOR COMMUNITY HEALTH INC
Doing business as
VIRGINIA BEACH FAMILY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 30, 2009
Last certification
Mar 30, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 15, 2003 in VA
Enrollment address
940 General Booth Blvd
Suite a
Virginia Beach, VA 23451-4857

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
49D1095204Virginia Beach Family Medical Center940 General Booth Boulevard - Suite a, Virginia Beach, VA 23451Certificate of waiverFeb 5, 2027

National Provider Directory

National Provider Directory
Tax ID family
Peninsula Inst Com HLT8 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
Ste C
Chesapeake, VA 23324
Phone (757) 218-1288

Ownership & related parties

All disclosed owners & managing parties 15

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 Director Jun 25, 2015
Stylie Williams Individual Corporate OfficerParliamentarian Sep 1, 2016
April Burwell Individual Corporate Director Feb 17, 2022
Dorothy Murray Individual Corporate Director Sep 10, 2014
Shirley Wills Individual Corporate OfficerVice Chair Apr 26, 2012
Asa Jenrette Individual Corporate Director Jun 25, 2015
Barrett Franklin Individual Corporate Director Mar 1, 2019
Yolanda Brannen Individual Corporate Director Feb 17, 2022
Angela Futrell Individual Corporate Director Jan 5, 2009
W-2 Managing Employee Jan 5, 2009
Juan L Garcia Individual Corporate Director Feb 1, 2021
Caryl Johnson Individual Corporate Director Feb 17, 2022
Denise Counce Individual Corporate Officer Sep 10, 2014
Wanda Allen Individual Corporate Director Jan 5, 2009
Aravia Johnson Individual Corporate Director Jun 25, 2015
Ruth Holmes Individual Corporate Director Jan 1, 2018

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 1

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": "1225843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238371200000",
    "number": "1902050875",
    "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",
            "fax_number": "757-928-3239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "940 GENERAL BOOTH BLVD",
            "address_2": "SUITE A",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234514857",
            "telephone_number": "757-591-0643",
            "fax_number": "757-928-3239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA INSTITUTE FOR COMMUNITY HEALTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-05",
        "last_updated": "2009-03-30",
        "status": "A",
        "authorized_official_last_name": "FUTRELL",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "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": "Virginia Beach Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Virginia Beach, VA

Sources for this page

Verify at the official NPI Registry.