Maria Tina Penalosa, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110001786 Issued in VA

Practice address

6333 Center Dr BLDG 16
Norfolk, VA 23502-4126

Phone

(757) 252-9500

Fax

(757) 962-9801

NPI assigned

Mar 22, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in VA

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

Specialty

Physician Assistant

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Sentara Medical GroupGroup PAC ID 8921903923, 1,396 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mpenalosa264271@direct.sentara.net

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

• Sentara Medical Group

  • Family Medicine Physician
  • Norfolk, VA
  • NPI 1265485270
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1142985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646179200000",
    "number": "1083673586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6333 CENTER DR BLDG 16",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235024126",
            "telephone_number": "757-252-9500",
            "fax_number": "757-962-9801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6333 CENTER DR BLDG 16",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235024126",
            "telephone_number": "757-252-9500",
            "fax_number": "757-962-9801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENALOSA",
        "first_name": "MARIA",
        "middle_name": "TINA",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-22",
        "last_updated": "2022-03-02",
        "certification_date": "2022-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110001786",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID FIRST HEALTH",
            "identifier": "10245036",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "541870984006",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRAVELERS RR MEDICARE",
            "identifier": "P00271162",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SENTARA OPTIMA",
            "identifier": "10004736P",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR GROUP",
            "identifier": "C13214",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hollis Pei
• Pelican Health Norfolk LLC
• Caitlin Pellant, CRNP
• Cailyn Aliya Singh Pellegrino
• Anthony R. Peluso, DDS
• Shaney Marie Penberthy, NP
• Mia Pendergrass
• Latarsha Penn
• Melinda Marie Christie Penn, M.D.
• Jayne R Penne, PA-C

• Physician Assistant in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.