Stephanie Gail Penacho, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

71015728A Issued in IN

Practice address

9410 Calumet Ave Ste 101
Munster, IN 46321-0018

Phone

(219) 922-8051

NPI assigned

Sep 17, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/CBEIBA

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.

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  Medicare reassignment NPD
• Nwi Clarity Clinic

  • Clinical Social Worker
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  • NPI 1619412160
  NPD
• Cardiovascular Consultants PC

  • Cardiovascular Disease Physician
  • Munster, IN
  • NPI 1538106711
  NPD (past)

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

{
    "created_epoch": "1726531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1285461822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9410 CALUMET AVE STE 101",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463210018",
            "telephone_number": "219-922-8051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9410 CALUMET AVE STE 101",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463210018",
            "telephone_number": "219-922-8051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENACHO",
        "first_name": "STEPHANIE",
        "middle_name": "GAIL",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-17",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IN",
            "license": "71015728A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Pawlicki, PT
• Mariah T Payne, D.C.
• Richard J Peach, O.D.
• Katie Peksenak, PA-C
• Russell W Pellar, MD
• Antoinette Perez, NP
• Michael Samuel Perez, D.D.S.
• Omar M Perez, M.D.
• Katie Persenaire
• Doreen Marie Peterson, D.D.S.

• Psychiatric/Mental Health Nurse Practitioner in Munster, IN
• Providers in Munster, IN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2024; 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.