Aneesha J Penn, MD

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

125.084204 Issued in IL

Practice address

720 N Bond St
Springfield, IL 62702-4952

Phone

(217) 545-8000

Fax

(217) 545-6544

NPI assigned

Mar 16, 2023

Last updated

Aug 8, 2024By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1678924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723075200000",
    "number": "1942901996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19662",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 N BOND ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627024952",
            "telephone_number": "217-545-8000",
            "fax_number": "217-545-6544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENN",
        "first_name": "ANEESHA",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-16",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IL",
            "license": "125.084204",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "IL",
            "license": "125.084204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alison M Peddycoart, APRN
• Matthew L Peecher, MD
• Jenna R. Pelc, NP
• Willa C Pelkey, CRNA
• Nicole L Pelser, NP
• Holly Diane Pennell, NP
• Abagail Lynn Pennington, BCBA
• Tatiana C Pennington, MA, LPC
• Pepper Brown and Associates, LLC
• James M. Perkins, CRNA

• Otolaryngology Physician in Springfield, IL
• Providers in Springfield, IL by specialty
• Otolaryngology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.