Dominic Pennisi, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A175794 Issued in CA

Practice address

832 S Fairmont Ave
Lodi, CA 95240-5117

Phone

(209) 365-9331

Fax

(209) 365-9359

NPI assigned

Dec 1, 2016

Last updated

Feb 11, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal Medicine

Education

Other, 2012

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Gill Medical Associates IncGroup PAC ID 9234539560, 5 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sky Healthcare Home Health Services Home health agency, Pleasanton, CA, CCN 559446
• St Joseph's Medical Center of Stockton Hospital, Stockton, CA, CCN 050084
• Adventist Health Lodi Memorial Hospital, Lodi, CA, CCN 050336

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Gill Medical Associates, Inc.

  • Internal Medicine Physician
  • Stockton, CA
  • NPI 1578149076

  Multi-Specialty

  Medicare reassignment Care Compare group NPD
• Pennisi Medical Group

  • Internal Medicine Physician
  • Stockton, CA
  • NPI 1043172760

  Multi-Specialty

  Medicare reassignment NPD Authorized official

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

• Lodi Memorial Hospital Association Inc

  dba Lodi Memorial Hospital

  • General Acute Care Hospital
  • Lodi, CA
  • NPI 1316938301
  Care Compare affiliation
• Port City Operating Company, LLC

  dba St. Joseph's Medical Center of Stockton

  • General Acute Care Hospital
  • Stockton, CA
  • NPI 1528190931
  Care Compare affiliation
• Sky HHS LLC

  dba Sky Healthcare Home Health Services

  • Home Health Agency
  • Elk Grove, CA
  • NPI 1750892857
  Care Compare affiliation

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

{
    "created_epoch": "1480550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644537600000",
    "number": "1548703036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1434",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952411434",
            "telephone_number": "209-462-7277",
            "fax_number": "866-950-0134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "832 S FAIRMONT AVE",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952405117",
            "telephone_number": "209-365-9331",
            "fax_number": "209-365-9359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNISI",
        "first_name": "DOMINIC",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-12-01",
        "last_updated": "2022-02-11",
        "certification_date": "2022-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A175794",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lance Peery, D.D.S.
• Milly A Pekke, RN
• Petwa Pekke
• Victoria Pelayo
• Emelyn Bernardo Penaloza, PTA
• Natharchia R Peoples
• Christa Pera, LMFT
• Betsy Pereida
• Christopher Perez
• Monica Lynn Perez

• Internal Medicine Physician in Lodi, CA
• Providers in Lodi, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2022; 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.