Active NPI
Keith Henry Penska, M.D.
- Child & Adolescent Psychiatry Physician
- Fort Belvoir, VA
National Provider Identifier
1053513176
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- 0101242211
- Practice address
- Alexander T. Augusta Military Medical Center
9300 Dewitt Loop
Fort Belvoir, VA 22060-5285 - Phone
- (571) 231-0401
- Fax
- (571) 231-6751
- NPI assigned
- Jun 1, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 0101242211 | VA | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Child & Adolescent Psychiatry Physician | 2084P0804X | 0101242211 | VA | Primary |
Addresses
Primary practice location
Alexander T. Augusta Military Medical Center
9300 Dewitt Loop
Fort Belvoir, VA 22060-5285
Mailing address
Fort Belvoir Community Hospital
9300 Dewitt Loop
Fort Belvoir, VA 22060-5285
Phone (571) 231-0401
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180656000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691971200000",
"number": "1053513176",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "FORT BELVOIR COMMUNITY HOSPITAL",
"address_2": "9300 DEWITT LOOP",
"city": "FORT BELVOIR",
"state": "VA",
"postal_code": "220605285",
"telephone_number": "571-231-0401",
"fax_number": "571-231-6751"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "ALEXANDER T. AUGUSTA MILITARY MEDICAL CENTER",
"address_2": "9300 DEWITT LOOP",
"city": "FORT BELVOIR",
"state": "VA",
"postal_code": "220605285",
"telephone_number": "571-231-0401",
"fax_number": "571-231-6751"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENSKA",
"first_name": "KEITH",
"middle_name": "HENRY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-01",
"last_updated": "2023-08-14",
"certification_date": "2023-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "VA",
"license": "0101242211",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "VA",
"license": "0101242211",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Belvoir, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; 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.