Active NPI
Patricia E Penovich, MD
- Neurology Physician
- Saint Paul, MN
National Provider Identifier
1548287436
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 35488
- Practice address
- 225 Smith Ave N
Suite 201
Saint Paul, MN 55102-2697 - Phone
- (651) 241-5290
- Fax
- (651) 241-5248
- NPI assigned
- Jul 16, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 35488 | MN | Primary |
Addresses
Primary practice location
225 Smith Ave N
Suite 201
Saint Paul, MN 55102-2697
Mailing address
225 Smith Ave N
Suite 201
Saint Paul, MN 55102-2697
Phone (651) 241-5290
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 893702800 | Medicaid | MN |
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)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153008000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1302480000000",
"number": "1548287436",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "225 SMITH AVE N",
"address_2": "SUITE 201",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551022697",
"telephone_number": "651-241-5290",
"fax_number": "651-241-5248"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "225 SMITH AVE N",
"address_2": "SUITE 201",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551022697",
"telephone_number": "651-241-5290",
"fax_number": "651-241-5248"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENOVICH",
"first_name": "PATRICIA",
"middle_name": "E",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-16",
"last_updated": "2011-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "MN",
"license": "35488",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "893702800",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.