Teresa A Pena, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

42447 Issued in MN

Practice address

4525 White Bear Pkwy
Suite 130
White Bear Lake, MN 55110-7651

Phone

(651) 564-4884

NPI assigned

May 16, 2006

Last updated

Oct 22, 2018By the provider in NPPES

Sex

Female

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 1, 2023 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: teresa.pena.1@19041.direct.athenahealth.com

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540166400000",
    "number": "1720030083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4525 WHITE BEAR PKWY",
            "address_2": "SUITE 130",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551107651",
            "telephone_number": "651-564-4884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4525 WHITE BEAR PKWY",
            "address_2": "SUITE 130",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551107651",
            "telephone_number": "651-564-4884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENA",
        "first_name": "TERESA",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-16",
        "last_updated": "2018-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "42447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Pascoe, LGSW
• Ty Evan Paulick, D.C.
• Peace of Mind Home Care, LLC
• Peddycoart Chiropractic Inc.
• Brenwyn Anne Lisa Peddycoart, DC
• Kathleen Jo Penn, LPCC
• Anna Lee Percival, OD
• Jessica Walker Perkins
• Danielle R Perry Ramirez, MD
• David Michael Perry, O.D.

• Family Medicine Physician in White Bear Lake, MN
• Providers in White Bear Lake, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2018; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.