NPIMap

Individual provider Active NPI

Penny Sue Hogan, MD

  • Family Medicine Physician
  • Xenia, OH
National Provider Identifier
1114013463
Registry record updated Nov 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35071125H Issued in OH
Practice address
1768 W Park SQ
Xenia, OH 45385-2667
Phone
(937) 372-3054
Fax
(937) 372-3084
NPI assigned
Oct 5, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 12, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35071125H OH Primary

Addresses

Primary practice location

1768 W Park SQ
Xenia, OH 45385-2667

Mailing address

1768 W Park SQ
Xenia, OH 45385-2667
Phone (937) 372-3054

Other identifiers 1

IdentifierTypeStateIssuer
2150032MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120626000109 OH Practitioner - Family Practice 1850203282 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Ohio State University College of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Health Physicians Springfield Primary Care LLCGroup PAC ID 7315361359, 37 clinicians

Practice addresses (Care Compare)

30 W McCreight Ave
Suite 208
Springfield, OH 45504-1853
Phone (937) 323-1187

Hospital & facility affiliations

  • Community Mercy Home Care, LLC Home health agency, Springfield, OH, CCN 367447
  • Kettering Homecare Home health agency, Kettering, OH, CCN 367778
  • Springfield Regional Medical Center Hospital, Springfield, OH, CCN 360086
  • Mercy Health - West Hospital Hospital, Cincinnati, OH, CCN 360234
  • Ohio Valley Surgical Hospital Hospital, Springfield, OH, CCN 360355
  • Kettering Health Greene Memorial Hospital, Xenia, OH, CCN 360026
  • Miami Valley Hospital Hospital, Dayton, OH, CCN 360051

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35071125HOHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Physicians Springfield Primary Care LLC Family Medicine CurrentSince Sep 1, 2020 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

30 W McCreight Ave
Ste 208
Springfield, OH 45504
Phone (937) 323-1187

900 Scioto St
Ste 4
Urbana, OH 43078
Phone (937) 653-4666

Interoperability endpoints

  • Direct secure messaging: phogan66204@direct.bsmhealth.org

Organizations & group practices 2

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.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352678400000",
    "number": "1114013463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1768 W PARK SQ",
            "city": "XENIA",
            "state": "OH",
            "postal_code": "453852667",
            "telephone_number": "937-372-3054",
            "fax_number": "937-372-3084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1768 W PARK SQ",
            "city": "XENIA",
            "state": "OH",
            "postal_code": "453852667",
            "telephone_number": "937-372-3054",
            "fax_number": "937-372-3084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOGAN",
        "first_name": "PENNY",
        "middle_name": "SUE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-05",
        "last_updated": "2012-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35071125H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2150032",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Xenia, OH

Sources for this page

Verify at the official NPI Registry.