NPIMap

Individual provider Active NPI

Jacob Pennington, D.O.

  • Adult Reconstructive Orthopaedic Surgery Physician
  • Port Charlotte, FL
National Provider Identifier
1174915235
Registry record updated Mar 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Reconstructive Orthopaedic Surgery PhysicianTaxonomy code 207XS0114X
License
OS17460 Issued in FL
Practice address
1641 Tamiami TRL
Port Charlotte, FL 33948-1018
Phone
(941) 629-6262
Fax
(941) 629-1782
NPI assigned
Feb 26, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Reconstructive Orthopaedic Surgery Physician 207XS0114X OS17460 FL Primary

Addresses

Primary practice location

1641 Tamiami TRL
Port Charlotte, FL 33948-1018

Mailing address

1641 Tamiami TRL
Port Charlotte, FL 33948-1018
Phone (941) 629-6262

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20210609000245 FL Practitioner - Orthopedic Surgery 2769805464 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physiotherapy Associates IncGroup PAC ID 3577470442, shared by 50 NPIs, 1,432 clinicians

Practice addresses (Care Compare)

1641 Tamiami TRL
Suite 1
Port Charlotte, FL 33948-1018
Phone (941) 629-6262

1940 Tamiami TRL
Port Charlotte, FL 33948-2105
Phone (941) 883-0083

Hospital & facility affiliations

  • Patients First Home Care LLC Home health agency, Sarasota, FL, CCN 687176
  • Aveanna Home Health Home health agency, Sarasota, FL, CCN 108480
  • Amedisys Home Health Home health agency, Port Charlotte, FL, CCN 108270
  • Millennium Home Care LLC Home health agency, Port Charlotte, FL, CCN 109401
  • Preferred Care Home Health Services Home health agency, Fort Myers, FL, CCN 109423
  • Adventhealth Port Charlotte Hospital, Port Charlotte, FL, CCN 100077
  • HCA Florida Fawcett Hospital Hospital, Port Charlotte, FL, CCN 100236

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement57
Knee replacement67
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Orthopedic Center of Charlotte County, PA Orthopaedic Surgery CurrentSince Aug 1, 2021 Accepting new patients
Advanced Orthopedic Center of Charlotte County, PA Orthopaedic Surgery CurrentSince Aug 1, 2021 Accepting new patients

Locations

1641 Tamiami Trl
Ste 1
Pt Charlotte, FL 33948
Phone (941) 629-6262

1641 Tamiami Trl
Pt Charlotte, FL 33948
Phone (941) 629-6262

350 Mary St
Ste F
Punta Gorda, FL 33950
Phone (941) 629-6262

350 Mary St
Punta Gorda, FL 33950
Phone (941) 639-1842

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Interoperability endpoints

  • Direct secure messaging: jpennington@aoc.emadirect.md
  • Direct secure messaging: jpennington@aocc1855.srs-direct.com

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 7

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": "1424908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677801600000",
    "number": "1174915235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1641 TAMIAMI TRL",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339481018",
            "telephone_number": "941-629-6262",
            "fax_number": "941-629-1782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1641 TAMIAMI TRL",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339481018",
            "telephone_number": "941-629-6262",
            "fax_number": "941-629-1782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNINGTON",
        "first_name": "JACOB",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-02-26",
        "last_updated": "2023-03-03",
        "certification_date": "2023-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XS0114X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": "FL",
            "license": "OS17460",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

Verify at the official NPI Registry.