DR. RAFFAELE PENNELLA (NPI# 1558400788) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558400788 |
| Entity Type | Individual |
| Full Name | DR. RAFFAELE PENNELLA |
| Credential | MD |
| Practice Address |
3808 S Greystone Ct Springfield MO 65804 |
| Practice Telephone | 4178893332 |
| Practice Fax Number | 4178811410 |
| Mailing Telephone | 4178893332 |
| Mailing Fax Number | 4178811410 |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2016-12-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 110288 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 208269902 | 05 | |
| AR | ARK BLUE SHIELD | 81292 | 01 |
| AR | 156123001 | 05 | |
| MO | MO BLUE SHIELD | 31905 | 01 |
| Street Address |
3808 S GREYSTONE CT |
| City | SPRINGFIELD |
| State | MO |
| Zip Code | 65804 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801866231 | Jenifer Dawn Insley | Dermatology | 3808 S Greystone Ct, Springfield, MO 65804-6561 | 2006-01-26 |
| 1356955231 | Erin F Lewis | Nurse Practitioner | 3808 S Greystone Ct, Springfield, MO 65804-6561 | 2020-09-08 |
| 1538773437 | Lesley Hawley Md LLC | Dermatology | 3808 S Greystone Ct, Springfield, MO 65804-6561 | 2020-09-08 |
| 1649793076 | Jenifer Insley Md LLC | Dermatology | 3808 S Greystone Ct, Springfield, MO 65804-6561 | 2017-07-18 |
| 1568992782 | Raffaele Pennella Md LLC | Dermatology | 3808 S Greystone Ct, Springfield, MO 65804-6561 | 2017-06-20 |
| 1013456045 | Erin H York | Physician Assistant | 3808 S Greystone Ct, Springfield, MO 65804-6561 | 2017-02-23 |
| 1356570576 | Amanda R Goddard | Physician Assistant | 3808 S Greystone Ct, Springfield, MO 65804-6561 | 2009-07-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790393049 | Kathy Forson | Nurse Practitioner | 1235 E. Cherokee St., Springfield, MO 65804 | 2020-07-22 |
| 1306498779 | Anne B Summers, LLC | Social Worker | 1310 E. Kingsley St., Ste C, Springfield, MO 65804 | 2019-07-15 |
| 1790241800 | Margaret Mary Hart | Social Worker | 1845 S Rogers Ave, Springfield, MO 65804 | 2019-02-13 |
| 1598254666 | Casey Carr | Optometrist | 1229 E Seminole St Ste 110, Springfield, MO 65804 | 2018-05-04 |
| 1124520697 | Shelby D White | Behavioral Analyst | 1300 E. Bradford Parkway, Springfield, MO 65804 | 2018-03-01 |
| 1316448343 | Karl Lynham | Massage Therapist | 1200 E Woodhurst Dr R300, Springfield, MO 65804 | 2018-02-25 |
| 1699273763 | Leah Wilson | Counselor | 1322 E Woodgate, Springfield, MO 65804 | 2018-01-24 |
| 1295242626 | Matthew Crisp | Physical Therapist | 3252 E Independence St, Springfield, MO 65804 | 2018-01-08 |
| 1518491042 | Crystal Spangler | Dietitian, Registered | 1965 S Fremont Ave Ste 220, Springfield, MO 65804 | 2017-04-11 |
| 1588012033 | Jeffrey Williams | Pharmacist | 1235 E. Cherokee, Springfield, MO 65804 | 2016-05-25 |
| Find all providers in zip 65804 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669090445 | Peter T Demos Md | Dermatology | 125 Liberty St Ste 206, Springfield, MA 01103-1109 | 2020-07-08 |
| 1952674798 | Ernest Lorenc | Dermatology | 2053 S Pin Oak Drive, Springfield, MO 65809-3142 | 2012-02-09 |
| 1437302452 | Dermatology Clinic of Springfield | Dermatology | 1605 G Street, Springfield, OR 97477-4227 | 2008-11-04 |
| 1750585741 | Nicole Marie Cassler | Dermatology | Oregon Medical Group Dermatology, 1007 Harlow Rd., Springfield, OR 97477-7124 | 2007-06-13 |
| 1942386677 | Larry Michael Newell | Dermatology | 2951 Montvale Dr, Suite B, Springfield, IL 62704-5341 | 2006-10-27 |
| 1063517746 | Adarsh A Kumar | Dermatology | 2040 Timberbrooke Drive, Springfield, IL 62702 | 2006-09-14 |
| 1558385989 | Siu Physicians & Surgeons, Inc | Dermatology | 201 E Madison St Ste 300, Springfield, IL 62702-5131 | 2006-07-27 |
| 1114961067 | Catherine L Laughlin | Dermatology | 1536 E Primrose St, Springfield, MO 65804-7928 | 2006-06-15 |
| 1891763868 | W Gerald Klingler | Dermatology | 355 W Carpenter Street Ste A, Springfield, IL 62702 | 2006-03-08 |
| 1801866231 | Jenifer Dawn Insley | Dermatology | 3808 S Greystone Ct, Springfield, MO 65804-6561 | 2006-01-26 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 65804 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.