NPIMap

Individual provider Active NPI

Joseph Vincent Penn, M.D.

  • Forensic Psychiatry Physician
  • Conroe, TX
National Provider Identifier
1508841123
Registry record updated Oct 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Forensic Psychiatry PhysicianTaxonomy code 2084F0202X
License
K7081 Issued in TX
Practice address
200 River Pointe Drive Utmb CMC
Suite #200
Conroe, TX 77304
Phone
(936) 494-4170
Fax
(936) 494-4195
NPI assigned
Dec 7, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2013

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Forensic Psychiatry Physician 2084F0202X MD08849 RI
Psychiatry Physician 2084P0800X MD08849 RI
Child & Adolescent Psychiatry Physician 2084P0804X MD08849 RI
Psychiatry Physician 2084P0800X K7081 TX
Forensic Psychiatry Physician 2084F0202X K7081 TX Primary
Child & Adolescent Psychiatry Physician 2084P0804X K7081 TX

Addresses

Primary practice location

200 River Pointe Drive Utmb CMC
Suite #200
Conroe, TX 77304

Mailing address

200 River Pointe Drive Utmb CMC
Suite #200
Conroe, TX 77304
Phone (936) 494-4170

Other identifiers 1

IdentifierTypeStateIssuer
7007282MedicaidRI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
K7081TXMDForensic Psychiatry Physician
MD08849RIMDChild & Adolescent Psychiatry Physician

Interoperability endpoints

  • Direct secure messaging: jpenn50946@uhssa.direct-ci.com

NPI Registry JSON

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

{
    "created_epoch": "1133913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381363200000",
    "number": "1508841123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 RIVER POINTE DRIVE UTMB CMC",
            "address_2": "SUITE #200",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "77304",
            "telephone_number": "936-494-4170",
            "fax_number": "936-494-4195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 RIVER POINTE DRIVE UTMB CMC",
            "address_2": "SUITE #200",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "77304",
            "telephone_number": "936-494-4170",
            "fax_number": "936-494-4195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENN",
        "first_name": "JOSEPH",
        "middle_name": "VINCENT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-07",
        "last_updated": "2013-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084F0202X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Forensic Psychiatry",
            "state": "RI",
            "license": "MD08849",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "RI",
            "license": "MD08849",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "RI",
            "license": "MD08849",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "K7081",
            "primary": false
        },
        {
            "code": "2084F0202X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Forensic Psychiatry",
            "state": "TX",
            "license": "K7081",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "TX",
            "license": "K7081",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7007282",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conroe, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.