Active NPI
Carol Pennell, NP
- Nurse Practitioner
- Syracuse, NY
National Provider Identifier
1639212368
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 331511
- Practice address
- 301 Prospect Ave
Health Office
Syracuse, NY 13203-1807 - Phone
- (315) 448-5111
- NPI assigned
- Feb 14, 2007
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 331511 | NY | Primary |
Addresses
Primary practice location
301 Prospect Ave
Health Office
Syracuse, NY 13203-1807
Mailing address
301 Prospect Ave
Health Office
Syracuse, NY 13203-1807
Phone (315) 448-5111
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
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 331511 | NY | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Josephs Medical PC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Liverpool, NY
- NPI 1942501747
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171411200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1639212368",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 PROSPECT AVE",
"address_2": "HEALTH OFFICE",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132031807",
"telephone_number": "315-448-5111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 PROSPECT AVE",
"address_2": "HEALTH OFFICE",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132031807",
"telephone_number": "315-448-5111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENNELL",
"first_name": "CAROL",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "NY",
"license": "331511",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Syracuse, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.