NPIMap

Organization Active NPI

Peninsula Community Health Services

  • Federally Qualified Health Center (FQHC)
  • Bremerton, WA
National Provider Identifier
1972157139
Registry record updated Jul 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PENINSULA COMMUNITY HEALTH SERVICES
Practice address
2400 Perry Ave
Bremerton, WA 98310-5139
Phone
(360) 377-3776
NPI assigned
Jul 26, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2019

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

Authorized official

Name
Ja-Angel Dewalt
Title
Revenue Cycle Manager
Phone
(360) 475-6711

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Medical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AM0700X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

2400 Perry Ave
Bremerton, WA 98310-5139

Mailing address

PO Box 960
Bremerton, WA 98337-0212
Phone (360) 377-3776

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040217000362 WA Part B Supplier - Clinic/Group Practice 9436044781 Receives reassigned benefits from 83 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bremerton, WA; Silverdale, WA; Shelton, WA; Poulsbo, WA; Port Orchard, WA; Kingston, WA; Belfair, WA
O20191212000408 WA Part A Provider - Federally Qualified Health Center (FQHC) 9436044781 Practice locations: Bremerton, WA

Federally qualified health center certification: CCN 941064

Legal name
PENINSULA COMMUNITY HEALTH SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 12, 2019
Last certification
Dec 12, 2019
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Enrollment address
2442 Perry Ave
Bremerton, WA 98310-5139

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory

Locations

2400 Perry Ave
Bremerton, WA 98310
Phone (360) 473-0747

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Christopher J Cook Individual Corporate DirectorBoard Member Sep 3, 2019
Jennifer Kreidler-Moss Individual Corporate OfficerCeo Sep 3, 2019 100%
W-2 Managing EmployeeCeo Sep 3, 2019 100%
Operational/Managerial ControlCeo Sep 3, 2019 100%
Susan Astle Individual Corporate DirectorBoard Member Sep 3, 2019
Monica Bernhard Individual Corporate DirectorBoard Member Sep 3, 2019
Yolanda N Fong Individual Corporate Director Sep 18, 2024
Neal Schanbeck Individual Corporate DirectorCommunity Member Dec 17, 2025
Lolita Afalla Individual Corporate Director Sep 18, 2024
Leslie Jackson Individual Corporate DirectorPatient Member Nov 19, 2025
Mary Berglind Individual Corporate Director Feb 1, 2023
Kristin Lillegard Individual Corporate DirectorCommunity Member Feb 18, 2026
Alfred D Pinkham Individual Corporate DirectorBoard Member Sep 3, 2019
Mary Dixon Individual Corporate DirectorPatient Member Aug 20, 2025
David Windom Individual Corporate Director Dec 1, 2019
Peninsula Community Health Services Organization, Bremerton, WA Corporation, Non-profit Operational/Managerial Control Sep 3, 2019 100%
Rogelio Valencia Individual Corporate Director Feb 1, 2023
Shannon Turner Individual Corporate Director May 21, 2025

All facility ownership & control disclosures 26

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Kitsap Community Health CentersPort Orchard, WA, CCN 501923 Federally qualified health center Operational/Managerial Control Jan 1, 2016
Peninsula Community Health ServicesBremerton, WA, CCN 501924 Federally qualified health center Operational/Managerial Control Jan 1, 2016
Peninsula Community Health ServicesBremerton, WA, CCN 941011 Federally qualified health center Operational/Managerial Control Jan 1, 2016
Peninsula Community Health Services BelfairBelfair, WA, CCN 941032 Federally qualified health center Operational/Managerial Control Apr 1, 2017
Peninsula Community Health Services KingstonKingston, WA, CCN 941033 Federally qualified health center Operational/Managerial Control May 1, 2017
Peninsula Community Health ServicesShelton, WA, CCN 941044 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2019
Peninsula Community Health ServicesBremerton, WA, CCN 941061 Federally qualified health center Operational/Managerial Control Sep 3, 2019
Peninsula Community Health ServicesBremerton, WA, CCN 941059 Federally qualified health center Operational/Managerial Control Sep 3, 2019
Peninsula Community Health ServicesBelfair, WA, CCN 941060 Federally qualified health center Operational/Managerial Control (100%) Sep 3, 2019
Peninsula Community Health ServicesSilverdale, WA, CCN 941070 Federally qualified health center Operational/Managerial Control May 1, 2020
Peninsula Community Health ServicesBremerton, WA, CCN 941074 Federally qualified health center Operational/Managerial Control (100%) Apr 20, 2020
Peninsula Community Health ServicesGig Harbor, WA, CCN 501005 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Nov 17, 2021
Nov 17, 2021
Peninsula Community Health ServicesBremerton, WA, CCN 501006 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 31, 2022
May 31, 2022
Peninsula Community Health ServicesBremerton, WA, CCN 501010 Federally qualified health center 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Sep 16, 2022
Sep 16, 2022
Peninsula Community Health ServicesPort Orchard, WA, CCN 501007 Federally qualified health center 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Sep 24, 2021
Sep 24, 2021
Peninsula Community Health ServicesBremerton, WA, CCN 501008 Federally qualified health center 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Oct 1, 2021
Oct 1, 2021
Peninsula Community Health ServicesKingston, WA, CCN 501013 Federally qualified health center 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Apr 14, 2022
Apr 14, 2022
Peninsula Community Health ServicesBremerton, WA, CCN 501012 Federally qualified health center 5% Or Greater Direct Ownership Interest Apr 14, 2022
Peninsula Community Health ServicesBremerton, WA, CCN 501016 Federally qualified health center 5% Or Greater Direct Ownership Interest Aug 23, 2022
Peninsula Community Health ServicesSilverdale, WA, CCN 501015 Federally qualified health center 5% Or Greater Direct Ownership Interest Sep 24, 2021
Peninsula Community Health ServicesSilverdale, WA, CCN 501037 Federally qualified health center 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Sep 8, 2023
Sep 8, 2023
Peninsula Community Health ServicesSilverdale, WA, CCN 501035 Federally qualified health center 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Sep 8, 2023
Sep 8, 2023
Peninsula Community Health ServicesPoulsbo, WA, CCN 501038 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Nov 1, 2023
Nov 1, 2023
Peninsula Community Health ServicesPort Orchard, WA, CCN 501067 Federally qualified health center 5% Or Greater Direct Ownership Interest Feb 5, 2025
Peninsula Community Health ServicesPoulsbo, WA, CCN 501068 Federally qualified health center 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jun 1, 2025
Jun 1, 2025
Peninsula Community Health ServicesBainbridge Island, WA, CCN 501079 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 12, 2026
Jan 12, 2026

Facilities with the same owner 26

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 26

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1564099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564099200000",
    "number": "1972157139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 960",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983370212",
            "telephone_number": "360-377-3776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 PERRY AVE",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983105139",
            "telephone_number": "360-377-3776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA COMMUNITY HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-26",
        "last_updated": "2019-07-26",
        "status": "A",
        "authorized_official_last_name": "DEWALT",
        "authorized_official_first_name": "JA-ANGEL",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGER",
        "authorized_official_telephone_number": "360-475-6711"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bremerton, WA

Sources for this page

Verify at the official NPI Registry.