Active NPI
Samuel Pennington
- Occupational Therapy Assistant
- Gering, NE
National Provider Identifier
1538857446
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 1103
- Practice address
- 2325 Lodge Dr
Gering, NE 69341-6825 - Phone
- (480) 466-4659
- NPI assigned
- Apr 27, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 1103 | NE | Primary |
Addresses
Primary practice location
2325 Lodge Dr
Gering, NE 69341-6825
Mailing address
2325 Lodge Dr
Gering, NE 69341-6825
Phone (480) 466-4659
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1103 | NE | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1682553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682553600000",
"number": "1538857446",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2325 LODGE DR",
"city": "GERING",
"state": "NE",
"postal_code": "693416825",
"telephone_number": "480-466-4659"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2325 LODGE DR",
"city": "GERING",
"state": "NE",
"postal_code": "693416825",
"telephone_number": "480-466-4659"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENNINGTON",
"first_name": "SAMUEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-04-27",
"last_updated": "2023-04-27",
"certification_date": "2023-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "NE",
"license": "1103",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gering, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.