Active NPI
Penny La Ruth White, MD
- Pediatrics Physician
- Chicago, IL
National Provider Identifier
1245254044
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 036122437
- Practice address
- 115 N Parkside Ave
Chicago, IL 60644-3040 - Phone
- (773) 295-3060
- NPI assigned
- Jul 26, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 00012637 | AL | |
| Pediatrics Physician | 208000000X | 036122437 | IL | Primary |
Addresses
Primary practice location
115 N Parkside Ave
Chicago, IL 60644-3040
Mailing address
3 Erie CT Ste 7140
Oak Park, IL 60302-2519
Phone (773) 537-0020
Other practice location 1
3 Erie Ct Ste 7140
Oak Park, IL 60302-2519
Phone (773) 537-0020
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 630904034 | Medicaid | AL | |
| 630901034 | Medicaid | AL | |
| 630900034 | Medicaid | AL | |
| 630902034 | Medicaid | AL | |
| 630903034 | Medicaid | AL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00012637 | AL | MD | Pediatrics Physician |
Interoperability endpoints
- penny.white.1@15508.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578009600000",
"number": "1245254044",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 ERIE CT STE 7140",
"city": "OAK PARK",
"state": "IL",
"postal_code": "603022519",
"telephone_number": "773-537-0020",
"fax_number": "773-537-0029"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 N PARKSIDE AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606443040",
"telephone_number": "773-295-3060"
}
],
"practiceLocations": [
{
"address_1": "3 Erie Ct Ste 7140",
"address_purpose": "LOCATION",
"city": "Oak Park",
"state": "IL",
"postal_code": "603022519",
"country_code": "US",
"telephone_number": "773-537-0020",
"fax_number": "773-537-0029",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WHITE",
"first_name": "PENNY",
"middle_name": "LA RUTH",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-26",
"last_updated": "2020-01-03",
"certification_date": "2020-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "AL",
"license": "00012637",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "036122437",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "630904034",
"state": "AL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "630901034",
"state": "AL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "630900034",
"state": "AL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "630902034",
"state": "AL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "630903034",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.