Emily G Pengelly, PA-C, MD

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

401 Bicentennial Way
Santa Rosa, CA 95403-2149

Phone

(707) 495-3732

NPI assigned

Feb 14, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Physician Assistant

Practice roles

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.

• Dartmouth-Hitchcock Clinic

  • Internal Medicine Physician
  • Lebanon, NH
  • NPI 1548210198
  NPD (past)

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

{
    "created_epoch": "1297641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710633600000",
    "number": "1699072470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "746 PATTRELL RD",
            "city": "NORWICH",
            "state": "VT",
            "postal_code": "050559479",
            "telephone_number": "210-723-1843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 BICENTENNIAL WAY",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954032149",
            "telephone_number": "707-495-3732"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "331 Olcott Dr Ste U3",
            "address_purpose": "LOCATION",
            "city": "White River Junction",
            "state": "VT",
            "postal_code": "050019263",
            "country_code": "US",
            "telephone_number": "802-295-6132",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PENGELLY",
        "first_name": "EMILY",
        "middle_name": "G",
        "name_prefix": "Ms.",
        "credential": "PA-C, MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-14",
        "last_updated": "2024-03-17",
        "certification_date": "2024-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aaron Peltz, D.P.T.
• Lawrence Peltz
• Van Arthur Pena, PH.D., M.D.
• Albert Peng, M.D.
• Jonathan A. Peng, M.D.
• Charles William Pengra, PH.D.
• Tom Penland
• Daniel R. Penn, MD
• Esther A. Penn, MD
• Aleae T. Pennette, DC,

• Student in an Organized Health Care Education/Training Program in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Student in an Organized Health Care Education/Training Program in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.