Carol Andrea Laurette Penn, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

25MB09343300 Issued in NJ

Practice address

72 Harrison Ave
Red Bank, NJ 07701-2375

Phone

(732) 363-6655

NPI assigned

Aug 4, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Nov 14, 2022 through Nov 14, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: carol.penn.p1@direct.fpcs.nextgenshare.com
• FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.71872

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.

• Ima Urgent Care

  • Urgent Care Clinic/Center
  • Shrewsbury, NJ
  • NPI 1427432244
  NPD (past)
• Practice Associates Medical Group

  • Internal Medicine Physician
  • Morristown, NJ
  • NPI 1427016385

  Family Medicine

  NPD (past)

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

{
    "created_epoch": "1312416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460073600000",
    "number": "1265711576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 2ND ST",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087013324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72 HARRISON AVE",
            "city": "RED BANK",
            "state": "NJ",
            "postal_code": "077012375",
            "telephone_number": "732-363-6655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENN",
        "first_name": "CAROL",
        "middle_name": "ANDREA LAURETTE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-08-04",
        "last_updated": "2016-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OT014041",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MB09343300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gail Pellicone, L.P.C.
• Lauren Pellizzi, LPC, LLC
• Victoria J Peloro, APN
• Dennise Pena
• Kenya Esther Penca, FNP
• Angela Pepe-Lage, LCSW
• Christopher Joseph Pepitone, D.C.
• Perfect Smile Dental Office PC
• Alexandria Joy Persico, MOT, OTR/L
• Susana Pestana-Szwarc, MS

• Family Medicine Physician in Red Bank, NJ
• Providers in Red Bank, NJ by specialty
• Family Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2016; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.