Roy Mason Pennington III, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

0101263036 Issued in VA

Practice address

1775 Forrestal Dr BLDG 33
Norfolk, VA 23551-0001

Phone

(757) 953-3647

NPI assigned

Apr 1, 2016

Last updated

Dec 1, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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 VA

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

State licenses

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

{
    "created_epoch": "1459468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1720441207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 WHITE STREET",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "28540",
            "telephone_number": "910-449-6500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1775 FORRESTAL DR BLDG 33",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235510001",
            "telephone_number": "757-953-3647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNINGTON",
        "first_name": "ROY",
        "middle_name": "MASON",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-04-01",
        "last_updated": "2021-12-01",
        "certification_date": "2021-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101263036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mia Pendergrass
• Latarsha Penn
• Melinda Marie Christie Penn, M.D.
• Jayne R Penne, PA-C
• Lori Mandy Pennington, OD
• Paige Elaina Penson
• Grace Mamarian Pentecost, D.D.S.
• People Helping All People
• Peoples Pharmacy LTC
• Peoples Pharmacy, LLC

• Internal Medicine Physician in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Internal Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2021; 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.