Ebony Sharette Penn

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209022466 Issued in IL

Practice address

1720 Shadow Ridge CT Apt H
Belleville, IL 62221-3914

Phone

(618) 409-3082

NPI assigned

May 12, 2021

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 IL, WA, NM, CA4 enrollments

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 4

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Central Health Plan of California, Inc.

  • Health Maintenance Organization
  • Diamond Bar, CA
  • NPI 1386714772
  Medicare reassignment NPD
• Molina Healthcare of California

  • Health Maintenance Organization
  • Long Beach, CA
  • NPI 1194811760
  Medicare reassignment NPD
• Molina Healthcare of Washington, Inc

  • Family Medicine Physician
  • Everett, WA
  • NPI 1912235060
  Medicare reassignment NPD
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  IL

  Medicare reassignment NPD
• Molina Care Connections, LLC.

  • Nurse Practitioner
  • Long Beach, CA
  • NPI 1407243223

  NM

  Medicare reassignment
• Molina Healthcare of Washington, Inc

  • Family Medicine Physician
  • Bothell, WA
  • NPI 1659897163
  NPD

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

{
    "created_epoch": "1620777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620777600000",
    "number": "1477137693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 SHADOW RIDGE CT APT H",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622213914",
            "telephone_number": "618-409-3082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 SHADOW RIDGE CT APT H",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622213914",
            "telephone_number": "618-409-3082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENN",
        "first_name": "EBONY",
        "middle_name": "SHARETTE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-12",
        "last_updated": "2021-05-12",
        "certification_date": "2021-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209022466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chris Jay Pearsall
• Alexander David Pederson, MD
• Bridgette L Peek, CRNA
• Gwendolyn C Pelate, CNA
• Pete L Pelletier, M.D.
• Rickie W. Penny, D.M.D.
• Beth Pense
• People Overcoming With Everlasting Results, Inc.
• Mattison N Perez, P.A.
• Periodontics of Southern Illinois

• Family Nurse Practitioner in Belleville, IL
• Providers in Belleville, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2021; 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.