Penny Attaway, DNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

209001693 Issued in IL

Practice address

1404 N 5TH Street
Vandalia, IL 62471

Phone

(618) 283-2000

Fax

(618) 283-2002

NPI assigned

Sep 27, 2006

Last updated

Dec 20, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner

Practice roles

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.

• Penny Attaway

  dba Medical Servics Unlimited

  • Rural Health Clinic/Center
  • Vandalia, IL
  • NPI 1528185170
  Authorized official Same address or phone
• MCS Counseling Services

  • Clinical Social Worker
  • Vandalia, IL
  • NPI 1578837415
  NPD (past)

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482192000000",
    "number": "1033200183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1404 N 5TH STREET",
            "city": "VANDALIA",
            "state": "IL",
            "postal_code": "62471",
            "telephone_number": "618-283-2000",
            "fax_number": "618-283-2002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1404 N 5TH STREET",
            "city": "VANDALIA",
            "state": "IL",
            "postal_code": "62471",
            "telephone_number": "618-283-2000",
            "fax_number": "618-283-2002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ATTAWAY",
        "first_name": "PENNY",
        "credential": "DNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-27",
        "last_updated": "2016-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209001693",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "371352296003",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE INS",
            "identifier": "L040233",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• 2102 Randolph Vandalia Professional, LLC
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• Kelli Jean Brunk Blank, D.M.D.

• Nurse Practitioner in Vandalia, IL
• Providers in Vandalia, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.