NPIMap

Organization Active NPI

Michael Pennachio, LLC

  • Ophthalmology Physician
  • Clermont, FL
National Provider Identifier
1477092187
Registry record updated Mar 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
ME45426 Issued in FL
Legal business name
MICHAEL PENNACHIO, LLC
Practice address
14244 Sr 50
Clermont, FL 34711-8003
Phone
(352) 227-1999
NPI assigned
Feb 14, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2017

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

Authorized official

Name
Mr. Michael Pennachio, MDNPI 1750312005
Title
Owner
Phone
(352) 227-1999

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X ME45426 FL Primary

Addresses

Primary practice location

14244 Sr 50
Clermont, FL 34711-8003

Mailing address

14244 Sr 50
Clermont, FL 34711-8003
Phone (352) 227-1999

Other names 1

  • Pennachio Eye Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170530002442 FL Part B Supplier - Clinic/Group Practice 0143597898 Receives reassigned benefits from 1 practitioner
Practice locations: Clermont, FL; Eustis, FL
O20171020001965 FL DME Supplier - Physician - Ophthalmology 0143597898 Practice locations: Clermont, FL

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1487030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488499200000",
    "number": "1477092187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14244 SR 50",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347118003",
            "telephone_number": "352-227-1999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14244 SR 50",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347118003",
            "telephone_number": "352-227-1999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL PENNACHIO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-14",
        "last_updated": "2017-03-03",
        "status": "A",
        "authorized_official_last_name": "PENNACHIO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "352-227-1999",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "FL",
            "license": "ME45426",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pennachio Eye",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Clermont, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2017; 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.