Physician Compare National (NPI:1790783330)

HEALTHCARE PROVIDER: CONNIE JO PENNINGTON M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1790783330
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2466538111
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080321000146
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	PENNINGTON
	Individual professional last name
Provider First Name	CONNIE
	Individual professional first name
Provider Middle Name	J
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	EASTERN VIRGINIA MEDICAL SCHOOL
	Individual professional's medical school
Graduation Year	1995
	Individual professional's medical school graduation year
Primary Specialty	COLORECTAL SURGERY (PROCTOLOGY)
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	2306 KNOB CREEK RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 100
	Group Practice or individual's line 2 address
City	JOHNSON CITY
	Group Practice or individual's city
State	TN
	Group Practice or individual's state
Zip Code	376042366
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	440184
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	FRANKLIN WOODS COMMUNITY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	440063
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	JOHNSON CITY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	440018
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	SYCAMORE SHOALS HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y