Crystal Pennino, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

166689 Issued in AK

Practice address

605 Gateway CT
Ketchikan, AK 99901-5672

Phone

(907) 228-6558

NPI assigned

Dec 18, 2017

Last updated

Dec 8, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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 1

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Ketchikan Indian CorporationGroup PAC ID 8426043761, 13 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Peacehealth Ketchikan Medical Center Hospital, Ketchikan, AK, CCN 021311

Merit-based Incentive Payment System (MIPS)

Final score

79.12 of 100Reported as group

Quality

81.91

Promoting interoperability

100

Improvement activities

40

Cost

40.93

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ketchikan Indian Corporation

  dba KIC Tribal Health Clinic

  • Primary Care Clinic/Center
  • Ketchikan, AK
  • NPI 1821120486

  TX

  Medicare reassignment Care Compare group

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

• Peacehealth

  dba Ketchikan Medical Center

  • Critical Access Hospital
  • Ketchikan, AK
  • NPI 1396705539
  Care Compare affiliation

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

{
    "created_epoch": "1513555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607385600000",
    "number": "1508372277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 CARLANNA LAKE RD",
            "city": "KETCHIKAN",
            "state": "AK",
            "postal_code": "999015611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 GATEWAY CT",
            "city": "KETCHIKAN",
            "state": "AK",
            "postal_code": "999015672",
            "telephone_number": "907-228-6558"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "120 Carlanna Lake Rd",
            "address_purpose": "LOCATION",
            "city": "Ketchikan",
            "state": "AK",
            "postal_code": "999015611",
            "country_code": "US",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "120 Carlanna Lake Rd",
            "address_purpose": "LOCATION",
            "city": "Ketchikan",
            "state": "AK",
            "postal_code": "999015611",
            "country_code": "US",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "120 Carlanna Lake Rd",
            "address_purpose": "LOCATION",
            "city": "Ketchikan",
            "state": "AK",
            "postal_code": "99901",
            "country_code": "US",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "120 Carlanna Lake Rd",
            "address_purpose": "LOCATION",
            "city": "Ketchikan",
            "state": "AK",
            "postal_code": "99901",
            "country_code": "US",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "120 Carlanna Lake Rd",
            "address_purpose": "LOCATION",
            "city": "Ketchikan",
            "state": "AK",
            "postal_code": "999015611",
            "country_code": "US",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "120 Carlanna Lake Rd",
            "address_purpose": "LOCATION",
            "city": "Ketchikan",
            "state": "AK",
            "postal_code": "99901",
            "country_code": "US",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "120 Carlanna Lake Rd",
            "address_purpose": "LOCATION",
            "city": "Ketchikan",
            "state": "AK",
            "postal_code": "99901",
            "country_code": "US",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "120 Carlanna Lake Rd",
            "address_purpose": "LOCATION",
            "city": "Ketchikan",
            "state": "AK",
            "postal_code": "999015611",
            "country_code": "US",
            "telephone_number": "907-247-9355",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "120 Carlanna Lake Rd",
            "address_purpose": "LOCATION",
            "city": "Ketchikan",
            "state": "AK",
            "postal_code": "999015611",
            "country_code": "US",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PENNINO",
        "first_name": "CRYSTAL",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-18",
        "last_updated": "2020-12-08",
        "certification_date": "2020-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AK",
            "license": "166689",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AK",
            "license": "22403",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peacehealth (Ketchikan Medical Center Home Health)
• Peacehealth (Ketchikan Medical Center)
• Peacehealth (Ketchikan Gen Hosp LTC)
• Jessica Peavy, CT
• Clarence Peele
• Ricki Perro
• Susan A Peters, CRNA
• Haley Marie Petersen
• William Peterson
• Benjamin Petiprin

• Family Nurse Practitioner in Ketchikan, AK
• Providers in Ketchikan, AK by specialty
• Family Nurse Practitioner in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2020; 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.