Elliot Carr Pennington, MD

Primary specialty

Pediatric Surgery PhysicianTaxonomy code 2086S0120X

License

1235365081 Issued in MI

Practice address

330 Barclay Ave NE Ste 202
Grand Rapids, MI 49503-2525

Phone

(616) 443-8007

Fax

(616) 458-0061

NPI assigned

Jun 8, 2009

Last updated

Mar 14, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

General Surgery

Education

University of Missouri, Columbia School of Medicine, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pediatric Surgeons of West Michigan PCGroup PAC ID 8426138223, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: epennington238434@epic00.corewelldirect.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pediatric Surgeons of West Michigan PC

  • Surgery Physician
  • Grand Rapids, MI
  • NPI 1477516110
  Medicare reassignment Care Compare group NPD
• Spectrum Health Hospitals

  dba Corewell Health Grand Rapids Hospital

  • General Acute Care Hospital
  • Grand Rapids, MI
  • NPI 1922090554
  NPD (past)

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

{
    "created_epoch": "1244419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678752000000",
    "number": "1235365081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 BARCLAY AVE NE STE 201",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032525",
            "telephone_number": "616-458-1722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 BARCLAY AVE NE STE 202",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032525",
            "telephone_number": "616-443-8007",
            "fax_number": "616-458-0061"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "333 N Santa Rosa",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782073108",
            "country_code": "US",
            "telephone_number": "713-798-1750 x2",
            "fax_number": "713-798-4693",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "330 Barclay Ave NE Ste 202",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495032525",
            "country_code": "US",
            "telephone_number": "616-458-1722",
            "fax_number": "616-458-0061",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PENNINGTON",
        "first_name": "ELLIOT",
        "middle_name": "CARR",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-08",
        "last_updated": "2023-03-14",
        "certification_date": "2023-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "TX",
            "license": "U2104",
            "primary": false
        },
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "MI",
            "license": "1235365081",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Epic",
            "affiliation": "Y",
            "endpointDescription": "Spectrum Health EMR Epic",
            "affiliationName": "Spectrum Health Hospitals",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "direct messaging",
            "address_1": "330 Barclay Ave NE Ste 202",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495032525",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Epic",
            "affiliation": "Y",
            "affiliationName": "Pediatric Surgeons Of West Michigan PC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Epic",
            "address_1": "330 Barclay Ave NE Ste 202",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495032525",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Pennant Physician Services
• David R Pennes, MD
• Marjorie Penning, PH.D.C.C.C.SLP
• Meredith Kay Penning, NP
• Alisha A Pennington, LBSW
• Mary Ryan Drew Pennington
• Julia Katherine Penny
• Patricia Anne Pentiak, MD
• Sudha Penumala
• Peoplecare Inc. (Metron Home Health)

• Pediatric Surgery Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Pediatric Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2023; 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.