Ismail S Penukonda, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD.204783 Issued in LA

Practice address

3213 Brighton CV
Grapevine, TX 76051-1101

Phone

(737) 786-5700

Fax

(817) 818-1805

NPI assigned

May 16, 2008

Last updated

Mar 29, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

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

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

{
    "created_epoch": "1210896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711670400000",
    "number": "1710144993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3213 BRIGHTON CV",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760511101",
            "telephone_number": "737-786-5700",
            "fax_number": "817-818-1805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3213 BRIGHTON CV",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760511101",
            "telephone_number": "737-786-5700",
            "fax_number": "817-818-1805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENUKONDA",
        "first_name": "ISMAIL",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-16",
        "last_updated": "2024-03-29",
        "certification_date": "2024-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "MD.204783",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Carmen Loren Pemberton, NP
• Richard Perez, D.D.S.
• Perimeter Outpatient Services, LLC
• Perinatal Medicine Associates, LLP
• Randall C Perkins, DO
• Linda B Perrin, RN, MSN, CPNP

• Family Medicine Physician in Grapevine, TX
• Providers in Grapevine, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 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.