Lara Ann Penn, FNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

2012041693 Issued in MO

Practice address

920 N Main St
O Fallon, MO 63366-1746

Phone

(314) 687-2731

NPI assigned

Jan 4, 2013

Last updated

Oct 26, 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

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in MO, IL, WI, OK4 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

Specialty

Nurse Practitioner

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

SSM Medical Group IncGroup PAC ID 6608776299, 565 clinicians

Dean Health Systems IncGroup PAC ID 7012827983, 1,174 clinicians

Saints Medical Group, LLCGroup PAC ID 7012914898, 430 clinicians

Agnesian Healthcare IncGroup PAC ID 1658289624, 392 clinicians

Physician Services Corporation of Southern Illinois IncGroup PAC ID 9234022567, 120 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lpenn190329@direct-ehr-ssmhc.com

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.

• SSM Medical Group, Inc.

  dba SSM Health Medical Group

  • Multi-Specialty Clinic/Center
  • Fenton, MO
  • NPI 1700966207
  Medicare reassignment Care Compare group NPD
• Agnesian Healthcare, Inc

  dba SSM Health St Agnes Hospital Fond Du Lac

  • General Acute Care Hospital
  • Fond Du Lac, WI
  • NPI 1346228541
  Medicare reassignment Care Compare group NPD
• Dean Health Systems, Inc

  dba SSM Health Dean Medical Group

  • Allergy & Immunology Physician
  • Madison, WI
  • NPI 1053358846
  Medicare reassignment Care Compare group NPD
• Physician Services Corporation of Southern Illinois Inc.

  dba SSM Health Medical Group

  • Internal Medicine Physician
  • Mount Vernon, IL
  • NPI 1831101807
  Medicare reassignment Care Compare group NPD
• Saints Medical Group, LLC

  • Family Medicine Physician
  • Oklahoma City, OK
  • NPI 1437195922
  Medicare reassignment Care Compare group NPD
• SSM Health Care St Louis

  dba SSM Health St Clare Fenton

  • Emergency Medicine Physician
  • Fenton, MO
  • NPI 1275586174
  Medicare reassignment NPD
• SSM Health Care St. Louis

  dba SSM Health St. Joseph Hospital - St. Charles Physician Billing

  • Emergency Medicine Physician
  • Saint Charles, MO
  • NPI 1427002922
  NPD
• Agnesian Healthcare Inc

  dba SSM Health Pharmacy

  • Community/Retail Pharmacy
  • Waupun, WI
  • NPI 1366417917
  NPD
• Agnesian Healthcare Inc

  dba SSM Health Fond Du Lac Regional Clinic

  • Family Medicine Physician
  • Fond Du Lac, WI
  • NPI 1730162991
  NPD
• Dean Health Systems, Inc.

  dba SSM Health Davis Duehr Dean Eye Care - Portage

  • Durable Medical Equipment & Medical Supplies
  • Portage, WI
  • NPI 1427085679
  NPD
• Saints Medical Group, LLC

  dba SSM Health Medical Group

  • Durable Medical Equipment & Medical Supplies
  • Edmond, OK
  • NPI 1730907700
  NPD
• SSM Health Care St. Louis

  dba SSM Health DePaul Hospital - St. Louis

  • General Acute Care Hospital
  • Bridgeton, MO
  • NPI 1598835308
  NPD (past)

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

{
    "created_epoch": "1357257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603670400000",
    "number": "1538406954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 955534",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631955534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 N MAIN ST",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633661746",
            "telephone_number": "314-687-2731"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7909 Highway N",
            "address_purpose": "LOCATION",
            "city": "Dardenne Prairie",
            "state": "MO",
            "postal_code": "633687382",
            "country_code": "US",
            "telephone_number": "636-625-1560",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PENN",
        "first_name": "LARA",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-04",
        "last_updated": "2020-10-26",
        "certification_date": "2020-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "2012041693",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2012041693",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lpenn190329@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "lpenn190329@direct-ehr-ssmhc.com",
            "address_1": "920 N Main St",
            "city": "O Fallon",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633661746",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "920 N Main St",
            "city": "O Fallon",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633661746",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Nurse Practitioner in O'Fallon, MO
• Providers in O'Fallon, MO by specialty
• Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 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.