Peter E. Penico III, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

ME36495 Issued in FL

Practice address

2020 59TH St W
Bradenton, FL 34209-4604

Phone

(941) 798-6303

NPI assigned

May 18, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

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

Practice roles

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.

• Braden ER SVCS Partnership LLC

  • Emergency Medicine Physician
  • Bradenton, FL
  • NPI 1467400788
  NPD (past)

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205452800000",
    "number": "1982657979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18167 US HIGHWAY 19 N",
            "address_2": "SUITE 285",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337643528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 59TH ST W",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342094604",
            "telephone_number": "941-798-6303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENICO III",
        "first_name": "PETER",
        "middle_name": "E.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2008-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "ME36495",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "41193",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036286700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pelots Pharmacy
• Chloe Alexandra Pena Garcia
• Jillian Lee Pendergast, CCC-SLP
• Julian Peng, MD
• Sheppard Peng, D.O.
• Michael Penker, RN
• Andrea Penley, CRNA
• Paige Koenig Pennebacker, M.D.
• Janifer Pepe, MS,PT
• Patricia L Pepper, PT

• Emergency Medicine Physician in Bradenton, FL
• Providers in Bradenton, FL by specialty
• Emergency Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2008; 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.