Vincent P Pennisi, M.D.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

G45259 Issued in CA

Practice address

1617 N California St.
Suite 2-a
Stockton, CA 95204

Phone

(209) 466-8546

Fax

(209) 466-3335

NPI assigned

Jul 21, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Obstetrics/Gynecology

Education

Georgetown University School of Medicine, 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

P. Gill Obstetrics and Gynecology Medical Group, Inc.Group PAC ID 9133019755, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: vincent.pennisi.1@15974.direct.athenahealth.com

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.

• P. Gill Obstetrics & Gynecology Medical Group, Inc.

  • Obstetrics & Gynecology Physician
  • Lodi, CA
  • NPI 1386636165
  Medicare reassignment Care Compare group NPD
• Hill Physicians Medical Group - PPO Program

  • Preferred Provider Organization
  • San Ramon, CA
  • NPI 1679011035
  NPD (past)

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

{
    "created_epoch": "1121904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663286400000",
    "number": "1487653341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1090",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952411090",
            "telephone_number": "209-334-1800",
            "fax_number": "209-334-1430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1617 N CALIFORNIA ST.",
            "address_2": "SUITE 2-A",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "95204",
            "telephone_number": "209-466-8546",
            "fax_number": "209-466-3335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNISI",
        "first_name": "VINCENT",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-21",
        "last_updated": "2022-09-16",
        "certification_date": "2022-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "G45259",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "G45259",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G452590",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1386636165",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gabriella Rae Gonzales Pena
• Amber Pence
• Tasha Lynn Penkova, MS, CCC-SLP
• Pennisi Medical Group
• Vincent Pennisi, MD
• Aleeza Rose Penny
• Cassandra Ariel Penny
• Marissa Penuelas
• Maurice Troy Peoples Jr.
• Jessica Perales

• Obstetrics & Gynecology Physician in Stockton, CA
• Providers in Stockton, CA by specialty
• Obstetrics & Gynecology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2022; 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.
• 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.