Nancy J Peckenpaugh Nutrition PLLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

NANCY J PECKENPAUGH NUTRITION PLLC

Practice address

1216 Trumansburg Rd
Ithaca, NY 14850-1314

Phone

(607) 272-1297

Fax

(607) 272-2366

NPI assigned

Mar 3, 2020

Organization subpart

No

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

Authorized official

Name

Ms. Nancy Jamison Peckenpaugh, RD, CDN, CDE, BC-ADMNPI 1063535391

Title

Disregarded Entity

Phone

(607) 272-1297

Specialties & licenses 1

Addresses

Other names 1

• Lifetime Nutrition Services Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Interoperability endpoints

• Direct secure messaging: lns.nancypeckenpaugh@140503.advancedmd-direct.com

Practitioners 1

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

• Nancy Jamison Peckenpaugh, MSED RD CDN CDE

  • Registered Dietitian
  • Ithaca, NY
  • NPI 1063535391

  Dietitian, Registered

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1583193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583193600000",
    "number": "1083249759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1216 TRUMANSBURG RD",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148501314",
            "telephone_number": "607-272-1297",
            "fax_number": "607-272-2366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1216 TRUMANSBURG RD",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148501314",
            "telephone_number": "607-272-1297",
            "fax_number": "607-272-2366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NANCY J PECKENPAUGH NUTRITION PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-03",
        "last_updated": "2020-03-03",
        "certification_date": "2020-03-03",
        "status": "A",
        "authorized_official_last_name": "PECKENPAUGH",
        "authorized_official_first_name": "NANCY",
        "authorized_official_middle_name": "JAMISON",
        "authorized_official_title_or_position": "DISREGARDED ENTITY",
        "authorized_official_telephone_number": "607-272-1297",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RD, CDN, CDE, BC-ADM"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "LNS.NancyPeckenpaugh@140503.advancedmd-direct.com",
            "affiliation": "N",
            "endpointDescription": "FAX: 607-272-2366 forwards CIE inbound",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "referrals",
            "address_1": "1216 Trumansburg Rd",
            "city": "Ithaca",
            "state": "NY",
            "country_code": "US",
            "postal_code": "148501314",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Lifetime Nutrition Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Registered Dietitian in Ithaca, NY
• Providers in Ithaca, NY by specialty
• Registered Dietitian in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.