Bucilla Health Services LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R156407-9 Issued in MN

Legal business name

BUCILLA HEALTH SERVICES LLC

Practice address

1500 McAndrews Rd W
Burnsville MN, MN 55337

Phone

(952) 892-9393

Fax

(952) 892-9395

NPI assigned

May 2, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Pennie Elizabeth Bucilla, APRN CNPNPI 1104225499

Title

Owner

Phone

(952) 892-9393

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Pennie Elizabeth Bucilla, APRN CNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Burnsville, MN
  • NPI 1104225499

  Single Specialty

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1525219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600732800000",
    "number": "1356830756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 MCANDREWS RD W",
            "city": "BURNSVILLE MN",
            "state": "MN",
            "postal_code": "55337",
            "telephone_number": "952-892-9393",
            "fax_number": "952-892-9395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 MCANDREWS RD W",
            "city": "BURNSVILLE MN",
            "state": "MN",
            "postal_code": "55337",
            "telephone_number": "952-892-9393",
            "fax_number": "952-892-9395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUCILLA HEALTH SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-02",
        "last_updated": "2020-09-22",
        "certification_date": "2020-09-22",
        "status": "A",
        "authorized_official_last_name": "BUCILLA",
        "authorized_official_first_name": "PENNIE",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "952-892-9393",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "APRN CNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "R156407-9",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.