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EBONY SHARETTE PENN
NPI 1477137693
Nurse Practitioner - Family in Belleville, IL

Active since May 12, 2021PECOS Enrolled
1720 SHADOW RIDGE CT APT H, BELLEVILLE, IL 62221(618) 409-3082 Get Directions Write a Review

NPPES record last updated: May 12, 2021. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Ebony Sharette Penn NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EBONY SHARETTE PENN (NPI 1477137693) is an individual family provider in Belleville, Illinois, licensed in Illinois (209022466) and active in the NPI registry since May 2021. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1477137693
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameEBONY SHARETTE PENN
Location Address1720 SHADOW RIDGE CT APT HBelleville, IL 62221-3914
Mailing Address1720 Shadow Ridge Ct Apt HBelleville, IL 62221-3914 · (618) 409-3082
Phone(618) 409-3082
Sole ProprietorNo
Enumeration DateMay 12, 2021
NPPES CertifiedMay 12, 2021
✔ NPI 1477137693 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in IL · 209022466
1720 SHADOW RIDGE CT APT H, Belleville, IL 62221
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ebony Sharette Penn is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 62221 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$88.44 typical visit price
range $56.28 – $173.35
Typical copayment $22.11 (range $14.07 – $43.33)
Most-billed visit code 99203
Established Patient
$99.71 typical visit price
range $17.51 – $139.99
Typical copayment $24.92 (range $4.37 – $34.99)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ebony Penn's NPI number?

The NPI number for Ebony Penn is 1477137693. It was assigned to this individual provider in the NPPES registry on May 12, 2021.

Where is Ebony Penn located?

Ebony Penn practices at 1720 Shadow Ridge Ct Apt H, Belleville, IL 62221. The listed phone number is (618) 409-3082.

What is Ebony Penn's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Ebony Penn enrolled in Medicare?

Yes. Ebony Penn is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Ebony Penn was last updated on May 12, 2021. NPI Profile syncs with the weekly NPPES data releases published by CMS.