Active NPI
Jayne R Penne, PA-C
- Medical Physician Assistant
- Norfolk, VA
National Provider Identifier
1578825105
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 0110003827
- Practice address
- 825 Fairfax Ave
Suite 445
Norfolk, VA 23507-1914 - Phone
- (757) 446-8920
- Fax
- (757) 446-5242
- NPI assigned
- Jun 11, 2012
- 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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 0110003827 | VA | Primary |
Addresses
Primary practice location
825 Fairfax Ave
Suite 445
Norfolk, VA 23507-1914
Mailing address
PO Box 936
Evms Medical Group
Norfolk, VA 23501-0936
Phone (757) 446-8920
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10120878P | Other | VA | OPTIMA HEALTH |
| 1578825105 | Medicaid | VA | |
| PAR | Other | VA | USA MANAGED CARE |
| PAR | Other | VA | CORVEL |
| 1578825105 | Medicaid | NC | |
| PAR | Other | VA | MULTIPLAN |
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
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433894400000",
"number": "1578825105",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 936",
"address_2": "EVMS MEDICAL GROUP",
"city": "NORFOLK",
"state": "VA",
"postal_code": "235010936",
"telephone_number": "757-446-8920",
"fax_number": "757-446-5242"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "825 FAIRFAX AVE",
"address_2": "SUITE 445",
"city": "NORFOLK",
"state": "VA",
"postal_code": "235071914",
"telephone_number": "757-446-8920",
"fax_number": "757-446-5242"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENNE",
"first_name": "JAYNE",
"middle_name": "R",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-11",
"last_updated": "2015-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "VA",
"license": "0110003827",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OPTIMA HEALTH",
"identifier": "10120878P",
"state": "VA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1578825105",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "USA MANAGED CARE",
"identifier": "PAR",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CORVEL",
"identifier": "PAR",
"state": "VA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1578825105",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MULTIPLAN",
"identifier": "PAR",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Norfolk, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.