Keith Bradley Pennycook, DO

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

86267 Issued in GA

Practice address

2870 Ronald Reagan Blvd Ste 103
Cumming, GA 30041-6092

Phone

(248) 601-4900

NPI assigned

Apr 15, 2019

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 GA

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

Specialty

Dermatology

Education

Michigan State University College of Osteopathic Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aqua Dermatology of Georgia PCGroup PAC ID 6800885757, 56 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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 and National Provider Directory roles.

• Aqua Dermatology of Georgia PC

  dba Goodman Dermatology, Skin Cancer Specialists PC & Aesthetics Center

  • Dermatology Physician
  • Marietta, GA
  • NPI 1114022167
  Medicare reassignment Care Compare group NPD
• Goodman Dermatology, PC

  • Dermatology Physician
  • Roswell, GA
  • NPI 1770801144
  Medicare reassignment NPD
• Dermatopathology Lab of Skin Cancer Specialists, P.C.

  • Clinical Medical Laboratory
  • Marietta, GA
  • NPI 1083044465
  NPD

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

{
    "created_epoch": "1555286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766102400000",
    "number": "1821651944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2870 RONALD REAGAN BLVD STE 103",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300416092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2870 RONALD REAGAN BLVD STE 103",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300416092",
            "telephone_number": "248-601-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNYCOOK",
        "first_name": "KEITH",
        "middle_name": "BRADLEY",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-15",
        "last_updated": "2025-12-19",
        "certification_date": "2025-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "GA",
            "license": "86267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gustave Joseph Peluso III, DMD
• Louisa Peluso, LCSW
• Pendley Business Ventures, Inc. (LEAP Pediatric Therapy Services)
• Julia Nicole Pendley, DPT
• Sara Penna, PHARMD
• Maureen Penoyer
• Kyle B Pepple, D.C.
• Lisa Perez, CSA
• Performance Care Group Inc (Stover Sports Injury & Wellness)
• Daria Perlin

• Dermatology Physician in Cumming, GA
• Providers in Cumming, GA by specialty
• Dermatology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2025; 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.