Jesse Pullen Penico, MD

Primary specialty

Infectious Disease PhysicianTaxonomy code 207RI0200X

License

21358 Issued in MS

Practice address

1340 Broad Ave
Suite 300
Gulfport, MS 39501-2404

Phone

(228) 575-2700

Fax

(228) 575-2709

NPI assigned

Jun 28, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jpenico@direct.mhg.com

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.

• Lsa, a PMC

  dba Lott, Sheffield Anesthesia

  • Medical Specialty Clinic/Center
  • Baton Rouge, LA
  • NPI 1134130222
  NPD (past)
• West Florida Medical Center Clinic PA

  dba Medical Center Clinic Ambulatory Surgical Center

  • Ambulatory Surgical Clinic/Center
  • Pensacola, FL
  • NPI 1043396245
  NPD (past)

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

{
    "created_epoch": "1119916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600732800000",
    "number": "1912904590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1810",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395021810",
            "telephone_number": "228-575-2700",
            "fax_number": "228-575-2710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 BROAD AVE",
            "address_2": "SUITE 300",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012404",
            "telephone_number": "228-575-2700",
            "fax_number": "228-575-2709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENICO",
        "first_name": "JESSE",
        "middle_name": "PULLEN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-28",
        "last_updated": "2020-09-22",
        "certification_date": "2020-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "FL",
            "license": "ME72349",
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "LA",
            "license": "015311",
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "MS",
            "license": "21358",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00112089",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1339181",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Page Leigh Pearson, LCSW, CTMH
• Susan Brandenburg Pearson, PT
• William Shelton Pearson, M.D.
• Susannah Brooke Peleaz, P-LPC
• David Shane Pendley, M.D.
• Chancelyn S Penn, CNP
• Lauren Penny, SLP
• Pensacola Health Trust Inc (The Boyington)
• Roy D Pepper Jr., DC
• Perez Vision Clinic

• Infectious Disease Physician in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Infectious Disease Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2020; 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.