Pennie Lowanda Smith, PA
Individual provider Active NPI Physician Assistant · Harrisburg, IL
NPI 1194732271 · NPPES record last updated Oct 23, 2020
Key facts
- NPI
- 1194732271
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 085001576 (IL)
- Practice address
- 205 N Main St
Harrisburg, IL 62946-1256 - Phone
- (618) 253-8450
- Fax
- (618) 253-8454
- NPI assigned
- Aug 2, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090224000575 | IL | Practitioner - Physician Assistant | 3173688223 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085001576 | IL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Health & Emergency Services, Inc. | Current |
Accepting new patients | |
| Community Health & Emergency Services, Inc. | Past | Accepting new patients | |
| Community Health & Emergency Services, Inc | Past | Accepting new patients |
Locations
13245 Kessler Rd
Cairo, IL 62914
Phone (618) 734-4400
205 N Main St
Harrisburg, IL 62946
Phone (618) 253-8450
Interoperability endpoints
- pennie.smith.p1@direct.chesi.nextgenshare.com
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085001576 | IL | Yes |
Addresses
Primary practice location
205 N Main St
Harrisburg, IL 62946-1256
Mailing address
PO Box 3008
Carbondale, IL 62902-3008
Phone (618) 734-4400
Other practice location 1
1201 Pine Street
Eldorado, IL 62930
Phone (618) 273-3361
Other providers in Harrisburg, IL
- Billy G Smith
- Charli Walter Leroy Smith Jr.
- Kimberly Dawn Smith
- Mary Darlene Smith
- Patricia Smith
- Southeastern Residential Alternatives, Inc.
- Southern Illinois Hospital Services
- Southern Illinois Hospital Services
- Southern Illinois Hospital Services
- Southern Illinois Medical Services, NFP
All providers in Harrisburg, IL · Physician Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 23, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.