Pennie Elizabeth Bucilla, APRN CNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R156407-9 CNP1972 Issued in MN

Practice address

1500 McAndrews Rd W
Burnsville, MN 55337

Phone

(952) 892-9393

Fax

(952) 800-8892

NPI assigned

Aug 22, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

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

Nurse Practitioner

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Bucilla Health Services LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Burnsville MN, MN
  • NPI 1356830756

  Single Specialty

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1408665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600819200000",
    "number": "1104225499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 MCANDREWS RD W",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "55337",
            "telephone_number": "952-892-9393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 MCANDREWS RD W",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "55337",
            "telephone_number": "952-892-9393",
            "fax_number": "952-800-8892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCILLA",
        "first_name": "PENNIE",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "APRN CNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-08-22",
        "last_updated": "2020-09-23",
        "certification_date": "2020-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "R156407-9",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "R156407-9 CNP1972",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MINNESOTA HEALTH CARE PROGRAMS (MHCP)",
            "identifier": "1104225499",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Building Bridges

• Psychiatric/Mental Health Nurse Practitioner in Burnsville, MN
• Providers in Burnsville, MN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2020; 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.