Paula Lynn Pengilly, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

CNP91014 Issued in ME

Practice address

17807 US Hwy 59 NE
Rose Medical Management
Thief River Falls, MN 56701-5670

Phone

(361) 413-5179

NPI assigned

Aug 30, 2005

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 WI

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Nurse Practitioner

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 and National Provider Directory roles.

• Prevea Clinic, Inc.

  • Internal Medicine Physician
  • Green Bay, WI
  • NPI 1306869276
  NPD
• Alegent Creighton Clinic

  dba CHI Health Clinic

  • Family Medicine Physician
  • Omaha, NE
  • NPI 1548287907
  NPD (past)
• Alegent Health Quick Care LLC

  dba CHI Health Quick Care LLC

  • Family Medicine Physician
  • Council Bluffs, IA
  • NPI 1083139224
  NPD (past)

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

{
    "created_epoch": "1125360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607040000000",
    "number": "1306839865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3461 37TH ST NE",
            "city": "INKSTER",
            "state": "ND",
            "postal_code": "582339306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17807 US HWY 59 NE",
            "address_2": "ROSE MEDICAL MANAGEMENT",
            "city": "THIEF RIVER FALLS",
            "state": "MN",
            "postal_code": "567015670",
            "telephone_number": "361-413-5179"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 County Road B",
            "address_purpose": "LOCATION",
            "city": "Shawano",
            "state": "WI",
            "postal_code": "541667072",
            "country_code": "US",
            "telephone_number": "715-524-2161",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "42 Dallas Hill Rd",
            "address_purpose": "LOCATION",
            "city": "Rangeley",
            "state": "ME",
            "postal_code": "049704032",
            "country_code": "US",
            "telephone_number": "207-864-3303",
            "fax_number": "207-864-2969",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PENGILLY",
        "first_name": "PAULA",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-30",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ME",
            "license": "CNP91014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn Victoria Olson, PHARMD
• Daniel L Paeth, MD
• Sanjay G Patel, MD
• Jan E. Pederson, PHARM.D.
• Pediatric Therapy Partners, Inc. (Pediatric Partners)
• Pennington & Red Lake County Public Health & Home Care
• Pennington County Human Services
• Pennington Health Services (Thief River Care Center)
• Beth Peterick, NP-C
• Courtney M Peters, LPC-S, LAPC

• Family Nurse Practitioner in Thief River Falls, MN
• Providers in Thief River Falls, MN by specialty
• Family Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2020; 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.