Jacquelyn Elise Pennie, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA5064 Issued in MA

Practice address

1 Lyons St
Dedham, MA 02026-5599

Phone

(508) 880-0012

NPI assigned

Jul 14, 2014

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 names 1

• Ms. Jacquelyn Elise Desjardins Former name

Medicare fee-for-service enrollment

Enrolled in MA

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, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Atrius Health IncGroup PAC ID 4789588641, 1,214 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jpenniepac167459@direct.atrius.masshiway.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.

• Atrius Health, Inc.

  • Internal Medicine Physician
  • Boston, MA
  • NPI 1871639914
  Medicare reassignment Care Compare group
• Atrius Health, Inc.

  • Internal Medicine Physician
  • Beverly, MA
  • NPI 1114265634

  Physician Assistant

  NPD
• Atrius Health, Inc.

  • Internal Medicine Physician
  • Peabody, MA
  • NPI 1356555015

  Physician Assistant

  NPD

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

{
    "created_epoch": "1405296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631491200000",
    "number": "1134536055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 LYONS STREET",
            "address_2": "ATRIUS HEALTH, INC",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02026",
            "telephone_number": "617-657-6495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 LYONS ST",
            "city": "DEDHAM",
            "state": "MA",
            "postal_code": "020265599",
            "telephone_number": "508-880-0012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNIE",
        "first_name": "JACQUELYN",
        "middle_name": "ELISE",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-14",
        "last_updated": "2021-09-13",
        "certification_date": "2021-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA5064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELYN",
            "last_name": "DESJARDINS",
            "middle_name": "ELISE",
            "prefix": "MS.",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jordan Pelletier
• Jason Peltier
• Shirley Pemberton
• Hilary Pena
• Leslie Penni, LICSW
• Robert Edward Perednia, D.P.T.
• Scott E Perkins, V.M.D.
• Remony Perlman
• Marcia Sherman Perna, MSW,LICSW
• Gloria Perng

• Physician Assistant in Dedham, MA
• Providers in Dedham, MA by specialty
• Physician Assistant in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2021; 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.