Active NPI
Michael Reynard Penn
- Peer Specialist
- Beaver, WV
National Provider Identifier
1699425017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- Practice address
- 175 Philpott LN
Beaver, WV 25813-9501 - Phone
- (304) 254-9262
- NPI assigned
- Mar 28, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Peer Specialist | 175T00000X | Primary |
Addresses
Primary practice location
175 Philpott LN
Beaver, WV 25813-9501
Mailing address
175 Philpott LN
Beaver, WV 25813-9501
Phone (304) 254-9262
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | michael.penn@ctcprograms.com |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1681948800000",
"number": "1699425017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "175 PHILPOTT LN",
"city": "BEAVER",
"state": "WV",
"postal_code": "258139501",
"telephone_number": "304-254-9262"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "175 PHILPOTT LN",
"city": "BEAVER",
"state": "WV",
"postal_code": "258139501",
"telephone_number": "304-254-9262"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENN",
"first_name": "MICHAEL",
"middle_name": "REYNARD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-03-28",
"last_updated": "2023-04-20",
"certification_date": "2023-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "michael.penn@ctcprograms.com",
"affiliation": "N",
"address_1": "175 Philpott Ln",
"city": "Beaver",
"state": "WV",
"country_code": "US",
"postal_code": "258139501",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Beaver, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.