Individual provider Active NPI

Patricia L. Penny, P.A.

  • Medical Physician Assistant
  • Jamaica, NY
National Provider Identifier
1679646939
Registry record updated Feb 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
008226-1 Issued in NY
Practice address
8647 164TH St
Jamaica, NY 11432-3450
Phone
(718) 658-2448
Fax
(718) 658-2603
NPI assigned
Nov 16, 2006
Last updated
Feb 2, 2012By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 2, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 008226-1 NY Primary

Addresses

Primary practice location

8647 164TH St
Jamaica, NY 11432-3450

Mailing address

8647 164TH St
Jamaica, NY 11432-3450
Phone (718) 658-2448

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070117000091 NY Practitioner - Physician Assistant 8426059585 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
008226-1NYMDPediatric Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Jun 22, 2012 Accepting new patients
Montefiore Medical Center CurrentSince Jun 22, 2012 Accepting new patients
CMC Radiological Services PC Past Accepting new patients
Caritas Emergency Medical Services, PC Past Accepting new patients
CMC Radiological Services PC Past Accepting new patients
Caritas Emergency Medical Services, PC Past Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

111 E 210th St
#100
Bronx, NY 10467
Phone (718) 405-8404

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328140800000",
    "number": "1679646939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8647 164TH ST",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114323450",
            "telephone_number": "718-658-2448",
            "fax_number": "718-658-2603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8647 164TH ST",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114323450",
            "telephone_number": "718-658-2448",
            "fax_number": "718-658-2603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNY",
        "first_name": "PATRICIA",
        "middle_name": "L.",
        "name_prefix": "Mrs.",
        "credential": "P.A.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-16",
        "last_updated": "2012-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "008226-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamaica, NY

Sources for this page

Verify at the official NPI Registry.