Kevin Matthew Pennycook, DO

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

OS19718 Issued in FL

Practice address

3268 Forum Blvd Ste 201
Fort Myers, FL 33905-5585

Phone

(239) 232-1176

Fax

(239) 244-9839

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 FL

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 Florida, PAGroup PAC ID 1153390414, 184 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

Practice roles

Locations

Networks

• Freedom Health HMO Network

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 Florida, PA

  • Dermatology Physician
  • Palm Beach Gardens, FL
  • NPI 1538270335
  Medicare reassignment Care Compare group NPD
• Naples Center for Dermatology & Riverchase Dermatology

  • Durable Medical Equipment & Medical Supplies
  • Cape Coral, FL
  • NPI 1538645775
  NPD

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

{
    "created_epoch": "1555286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693526400000",
    "number": "1922661040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 VILLAGE SQUARE XING STE 290",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334104552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3268 FORUM BLVD STE 201",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339055585",
            "telephone_number": "239-232-1176",
            "fax_number": "239-244-9839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNYCOOK",
        "first_name": "KEVIN",
        "middle_name": "MATTHEW",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-15",
        "last_updated": "2023-09-01",
        "certification_date": "2023-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "OS19718",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carlo T Penaranda, P.T.
• Dexter Penaranda
• Alexander M Pendino, D.O.
• Sharica Pennington
• Jeffrey Aaron Pennock I, OTR
• Zachary William Penrod, DO
• Heloisa Pentian, ARNP - FNP-C
• James W Penuel Jr., MD
• Emily Sue Pepe
• Shantell Pepe, LMHC

• Dermatology Physician in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2023; 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.