NPIMap

Individual provider Active NPI

Owano M Pennycooke, MD

  • Vascular Surgery Physician
  • Freehold, NJ
National Provider Identifier
1013150267
Registry record updated Mar 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
MD492025C Issued in PA
Practice address
901 W Main St Ste 107
Freehold, NJ 07728-2537
Phone
(732) 677-1091
Fax
(732) 431-4640
NPI assigned
Apr 16, 2009
Last updated
Mar 2, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X MD492025C PA Primary
Surgery Physician 208600000X 25MA08547000 NJ
Vascular Surgery Physician 2086S0129X 25MA08547000 NJ

Addresses

Primary practice location

901 W Main St Ste 107
Freehold, NJ 07728-2537

Mailing address

PO Box 416457
Boston, MA 02241-6457
Phone (844) 362-1735

Other practice location 1

46 Newman Springs Rd E Ste D
Red Bank, NJ 07701-1531
Phone (732) 677-1091

Other practice location 2

179 N Reading Rd
Ephrata, PA 17522-1647
Phone (717) 738-0167

Other practice location 3

252 S 4th St Fl 2
Lebanon, PA 17042-6111
Phone (717) 270-3751

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, PA, GA3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20110809000465 NJ Practitioner - Vascular Surgery 6800065822 Reassigns benefits to 1 organization
I20260312003750 PA Practitioner - Vascular Surgery 6800065822 Reassigns benefits to 1 organization
I20260410000045 GA Practitioner - Vascular Surgery 6800065822 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
Rutgers New Jersey Medical School, 1999
Medicare assignment
May accept Medicare assignment
Group practices
Heartstride Health LLCGroup PAC ID 7315443314, 8 clinicians
Institute of Restorative MedicineGroup PAC ID 8123565926, 3 clinicians

Practice addresses (Care Compare)

1825 Hwy 34 E 3400
Newnan, GA 30265-6433
Phone (770) 400-9588

2326 Hwy 34 E
Suite 200
Newnan, GA 30265-1328
Phone (770) 585-2384

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal1-10
Leg revascularization (restoring blood flow)17
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25MA08547000NJMDVascular Surgery Physician
MD492025CPAMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ea Health - New Jersey LLC CurrentSince Jul 19, 2023 Accepting new patients
Wellspan Medical Group CurrentSince Mar 3, 2026 Accepting new patients
Wellspan Medical Group CurrentSince Mar 3, 2026 Accepting new patients

Locations

727 N Beers St
Holmdel, NJ 07733
Phone (732) 714-2700

1 Riverview Plz
Red Bank, NJ 07701
Phone (732) 530-2204

179 N Reading Rd
Ephrata, PA 17522
Phone (717) 738-0167

252 S 4th St
#2
Lebanon, PA 17042
Phone (717) 270-3751

252 S 4th St
Fl 2
Lebanon, PA 17042
Phone (717) 270-3751

Networks

  • FL HMO
  • AL HMO D-SNP
  • devoted network organization-14bfd35d-d818-4696-813b-340339e464ef
  • FL HMO D-SNP
  • TN PPO C-SNP
  • AL HMO
  • devoted network organization-25ba88d3-d0a6-4213-84f1-eef6f2b59f68
  • devoted network organization-d5084670-562f-408b-b100-22a1a4ef4d82
  • TN PPO
  • FL HMO C-SNP

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EEHHBD/Endpoint/EEHHBD
  • FHIR API: https://fhir4.healow.com/fhir/r4/EFDHDD/Endpoint/EFDHDD
  • Direct secure messaging: opennycooke425381@direct.ahsys.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1239840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772409600000",
    "number": "1013150267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 416457",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022416457",
            "telephone_number": "844-362-1735",
            "fax_number": "973-290-7495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 W MAIN ST STE 107",
            "city": "FREEHOLD",
            "state": "NJ",
            "postal_code": "077282537",
            "telephone_number": "732-677-1091",
            "fax_number": "732-431-4640"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "46 Newman Springs Rd E Ste D",
            "address_purpose": "LOCATION",
            "city": "Red Bank",
            "state": "NJ",
            "postal_code": "077011531",
            "country_code": "US",
            "telephone_number": "732-677-1091",
            "fax_number": "732-431-4640",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "179 N Reading Rd",
            "address_purpose": "LOCATION",
            "city": "Ephrata",
            "state": "PA",
            "postal_code": "175221647",
            "country_code": "US",
            "telephone_number": "717-738-0167",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "252 S 4th St Fl 2",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "PA",
            "postal_code": "170426111",
            "country_code": "US",
            "telephone_number": "717-270-3751",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PENNYCOOKE",
        "first_name": "OWANO",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-16",
        "last_updated": "2026-03-02",
        "certification_date": "2026-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "PA",
            "license": "MD492025C",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NJ",
            "license": "25MA08547000",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NJ",
            "license": "25MA08547000",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Freehold, NJ

Sources for this page

Verify at the official NPI Registry.