Karen M Pennelli, P.A

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

008027 Issued in GA

Practice address

470 Northside Cherokee Blvd Ste 170
Canton, GA 30115-8029

Phone

(770) 721-9540

Fax

(770) 721-9541

NPI assigned

Sep 27, 2006

Last updated

Apr 14, 2020By 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 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Northwestern University Feinberg Medical School, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northside Surgical Professional Services LLCGroup PAC ID 8628253424, 367 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northside Hospital Forsyth Hospital, Cumming, GA, CCN 110005
• Northside Hospital Cherokee Hospital, Canton, GA, CCN 110008

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northside Surgical Professional Services LLC

  • Surgery Physician
  • Atlanta, GA
  • NPI 1356630990
  Medicare reassignment Care Compare group
• Advanced Joint Surgery Specialists, LLC

  • Orthopaedic Surgery Physician
  • Atlanta, GA
  • NPI 1477929206
  Medicare reassignment
• Wellstar Medical Group, LLC

  dba WellStar Family Medicine ACW

  • Family Medicine Physician
  • Kennesaw, GA
  • NPI 1558664003
  Medicare reassignment
• Wellstar Medical Group, LLC

  • Multi-Specialty Clinic/Center
  • Marietta, GA
  • NPI 1275992240
  NPD
• Wellstar Medical Group, LLC

  dba WellStar Neuropsychology

  • Clinical Neurophysiology Physician
  • Marietta, GA
  • NPI 1689967697
  NPD
• Boston Urology Institute LLC

  • Clinical Medical Laboratory
  • Framingham, MA
  • NPI 1336415470
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Northside Hospital, Inc.

  dba Northside Hospital Cherokee

  • General Acute Care Hospital
  • Canton, GA
  • NPI 1225050396
  Care Compare affiliation
• Northside Hospital, Inc.

  dba Northside Hospital Forsyth

  • General Acute Care Hospital
  • Cumming, GA
  • NPI 1376574277
  Care Compare affiliation

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586822400000",
    "number": "1811088685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 OLD MILTON PKWY # C",
            "address_2": "SUITE 290",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300053707",
            "telephone_number": "770-667-4337",
            "fax_number": "770-667-4338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "470 NORTHSIDE CHEROKEE BLVD STE 170",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301158029",
            "telephone_number": "770-721-9540",
            "fax_number": "770-721-9541"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3400 Old Milton Pkwy # C",
            "address_2": "Suite 290",
            "address_purpose": "LOCATION",
            "city": "Alpharetta",
            "state": "GA",
            "postal_code": "300053707",
            "country_code": "US",
            "telephone_number": "770-667-4337",
            "fax_number": "770-667-4338",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PENNELLI",
        "first_name": "KAREN",
        "middle_name": "M",
        "credential": "P.A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-27",
        "last_updated": "2020-04-14",
        "certification_date": "2020-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "784",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "008027",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MA",
            "license": "PA784",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kpennelli143388@directwellstar.org",
            "affiliation": "N",
            "address_1": "2500 Hospital Blvd Ste 310",
            "city": "Roswell",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300764947",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Christopher Peel, PHARMD
• Sarah Turner Peele, RD
• Carolyn Pellegrino, MS, CCC-SLP
• Hannah Penaluna, RM
• Dolly Chanta'E Penn, MD, MSCR
• Manuel R Peralta
• Carolyn Perilli, RN
• Perimeter Anesthesia LLC
• Lauren Peterson, M.ED., CCC-SLP
• Ryan Petrini, DC

• Physician Assistant in Canton, GA
• Providers in Canton, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.