Peninsula Plastic Surgery Center-ASC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

0101052484 Issued in VA

Legal business name

PENINSULA PLASTIC SURGERY CENTER-ASC

Practice address

324 Monticello Ave
Williamsburg, VA 23185-2834

Phone

(757) 229-5200

Fax

(757) 229-2692

NPI assigned

Jan 3, 2007

Organization subpart

No

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

Authorized official

Name

Dr. John M. Pitman III, M.D.NPI 1275635229

Title

Physician

Phone

(757) 229-5200

Specialties & licenses 1

Addresses

Other identifiers 7

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John M Pitman III, MD

  • General Practice Physician
  • Williamsburg, VA
  • NPI 1275635229
  NPD Authorized official
• Krystal Allbritton, PA

  • Physician Assistant
  • San Antonio, TX
  • NPI 1245425305
  NPD (past)

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1942357124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 MONTICELLO AVE",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231852834",
            "telephone_number": "757-229-5200",
            "fax_number": "757-229-2692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 MONTICELLO AVE",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231852834",
            "telephone_number": "757-229-5200",
            "fax_number": "757-229-2692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA PLASTIC SURGERY CENTER-ASC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "PITMAN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "757-229-5200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "VA",
            "license": "0101052484",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "289668",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "289669",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SENTARA OPTIMA",
            "identifier": "54536",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "213427",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "432612",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5209080",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOUTHERN HEALTH",
            "identifier": "121242",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shane H Peng, M.D.
• Peninsula Anesthesia Consultants LLC
• Peninsula Dermatology Skin Cancer Surgery Center, Inc
• Peninsula Plastic Surgery Center
• Peninsula Plastic Surgery Center
• Peninsula Psychotherapy Center
• Peninsula Surgery Center II LLC
• Pentus Health Primary Care WB LLC
• Andres Peralta, FNP-C
• Sonya Nadine Peretti-Hull, LPC

• Ambulatory Surgical Clinic/Center in Williamsburg, VA
• Providers in Williamsburg, VA by specialty
• Ambulatory Surgical Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.