NPIMap

Organization Active NPI

Robert Elden Pennington MD, PHD, PC

  • Sports Medicine (Neuromusculoskeletal Medicine) Physician
  • Roswell, NM
National Provider Identifier
1780873547
Registry record updated Oct 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Neuromusculoskeletal Medicine) PhysicianTaxonomy code 204C00000X
License
95321 Issued in NM
Legal business name
ROBERT ELDEN PENNINGTON MD, PHD, PC
Practice address
1 El Arco Iris Dr
Roswell, NM 88201-7711
Phone
(505) 625-5512
Fax
(505) 625-1013
NPI assigned
Oct 17, 2007
Last updated
Oct 17, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2007

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

Authorized official

Name
Dr. Robert Pennington, M.D., PHD
Title
Physician Owner
Phone
(505) 625-5512

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Neuromusculoskeletal Medicine) Physician 204C00000X 95321 NM Primary
Pain Medicine Physician 208VP0000X 95321 NM

Addresses

Primary practice location

1 El Arco Iris Dr
Roswell, NM 88201-7711

Mailing address

1 El Arco Iris Dr
Roswell, NM 88201-7711
Phone (505) 625-5512

Other identifiers 1

IdentifierTypeStateIssuer
72080MedicaidNM

National Provider Directory

National Provider Directory

Locations

1 El Arco Iris Dr
Roswell, NM 88201
Phone (505) 625-5512

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1192579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192579200000",
    "number": "1780873547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 EL ARCO IRIS DR",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882017711",
            "telephone_number": "505-625-5512",
            "fax_number": "505-625-1013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 EL ARCO IRIS DR",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882017711",
            "telephone_number": "505-625-5512",
            "fax_number": "505-625-1013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT ELDEN PENNINGTON MD, PHD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-17",
        "last_updated": "2007-10-17",
        "status": "A",
        "authorized_official_last_name": "PENNINGTON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "505-625-5512",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D., PHD"
    },
    "taxonomies": [
        {
            "code": "204C00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": "NM",
            "license": "95321",
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "NM",
            "license": "95321",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "72080",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.