Jake Martin Penick, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

901900 Issued in MS

Practice address

1225 N State St
Jackson, MS 39202-2064

Phone

(601) 968-1000

NPI assigned

Feb 1, 2024

Sex

Male

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 MS

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Perioperative Services of Mississippi, LLCGroup PAC ID 8921365255, 98 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mississippi Baptist Medical Center Hospital, Jackson, MS, CCN 250102

Medicare enrollment (NPD)

Enrolled

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.

• Perioperative Services of Mississippi, LLC

  • Anesthesiology Physician
  • Jackson, MS
  • NPI 1881123123
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mississippi Baptist Medical Center, Inc.

  • General Acute Care Hospital
  • Jackson, MS
  • NPI 1710909585
  Care Compare affiliation

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

{
    "created_epoch": "1706745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707264000000",
    "number": "1376306480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 BENTONWOOD DR",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390423301",
            "telephone_number": "601-572-4815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392022064",
            "telephone_number": "601-968-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENICK",
        "first_name": "JAKE",
        "middle_name": "MARTIN",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-02-01",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MS",
            "license": "901900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sanedra Pegues
• Dora M Pelletier, MD
• Melissa B Pender, NP
• Brianna Michelle Pendergrass, FNP-BC
• Desiree Buehler Pendergrass, M.D.
• Jennifer Penick, MS
• Jeffrey Lance Penn
• Connor Pennington, PHARMD.
• Amanda S Penny, M.D
• Donald Penzien, PHD

• Certified Registered Nurse Anesthetist in Jackson, MS
• Providers in Jackson, MS by specialty
• Certified Registered Nurse Anesthetist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.