Rachael Vaughn Pennell, MSW, LCSW-A

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C011762 Issued in NC

Practice address

8401 Medical Plaza Dr Ste 300
Charlotte, NC 28262-8702

Phone

(704) 316-6561

Fax

(704) 384-1977

NPI assigned

Jul 18, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Rachael Anne Vaughn Former name

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Charlotte Community Health Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • Charlotte, NC
  • NPI 1528363868
  Medicare reassignment NPD
• Charlotte Community Health Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • Charlotte, NC
  • NPI 1073367249
  NPD
• Youth Villages

  • Community/Behavioral Health Agency
  • Durham, NC
  • NPI 1316170475
  NPD (past)
• Youth Villages

  • Community/Behavioral Health Agency
  • Durham, NC
  • NPI 1720453236
  NPD (past)

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

{
    "created_epoch": "1468800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633305600000",
    "number": "1285087031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8401 MEDICAL PLAZA DR STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282628702",
            "telephone_number": "704-316-6561",
            "fax_number": "704-384-1977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8401 MEDICAL PLAZA DR STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282628702",
            "telephone_number": "704-316-6561",
            "fax_number": "704-384-1977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNELL",
        "first_name": "RACHAEL",
        "middle_name": "VAUGHN",
        "credential": "MSW, LCSW-A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-18",
        "last_updated": "2021-10-04",
        "certification_date": "2021-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C011762",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P010710",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00550523",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RACHAEL",
            "last_name": "VAUGHN",
            "middle_name": "ANNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Hari Penmetsa
• Frances Elizabeth Logan Penn, M.D, M.S.P.H.
• Jada Marchette Penn, LCSWA
• Shanyia Penn
• Michael Penna, DO
• Jessie Angela Penner, LMFTA
• Darcy Rae Pennetta
• Kaci Ann Pennington, NCC
• Kaitlyn Nicole Pennington, PHARMD
• Lisa Pennington, PH.D.

• Clinical Social Worker in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.