EBONY SHARETTE PENN
NPI 1477137693
Nurse Practitioner - Family in Belleville, IL
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
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Ebony Sharette Penn is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignments
5Medicare enrollment records show Ebony Penn reassigns Medicare billing to 5 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Dallas, TX 75244
- Reassigned Medicare billing, Illinois enrollment
- 712 clinicians in this Medicare group
Pomona, CA 91766
- Reassigned Medicare billing, California enrollment
- 339 clinicians in this Medicare group
Diamond Bar, CA 91765
- Reassigned Medicare billing, California enrollment
- 283 clinicians in this Medicare group
Long Beach, CA 90802
- Reassigned Medicare billing, New Mexico enrollment
- 49 clinicians in this Medicare group
Bothell, WA 98021
- Reassigned Medicare billing, Washington enrollment
- 207 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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.
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.
Which organizations bill Medicare for Ebony Penn's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Ebony Penn reassigns Medicare benefits to 5 organizations: Signify Health Medical Associates, PLLC (Dallas, TX), Molina Healthcare Of California (Pomona, CA), Central Health Plan Of California, Inc. (Diamond Bar, CA), Molina Care Connections, LLC. (Long Beach, CA) and Molina Healthcare Of Washington, Inc (Bothell, WA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Ebony Penn's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Ebony Penn was last updated on May 12, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Ebony Sharette Penn · NPI 1477137693
Family physician in Belleville, Illinois. Individual provider, active in the CMS NPPES registry since May 12, 2021.
## Identity
- **NPI:** 1477137693 (Entity type: Individual)
- **Enumerated:** May 12, 2021
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** 209022466 (Illinois)
- **Sole proprietor:** No
## Practice location
- **Address:** 1720 SHADOW RIDGE CT APT H, Belleville, IL 62221-3914
- **Phone:** (618) 409-3082
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 5 organizations under Medicare reassignment (form CMS-855R): Signify Health Medical Associates, PLLC (NPI 1750845863, Dallas, TX); Molina Healthcare Of California (NPI 1932214228, Pomona, CA); Central Health Plan Of California, Inc. (NPI 1386714772, Diamond Bar, CA); Molina Care Connections, LLC. (NPI 1407243223, Long Beach, CA); Molina Healthcare Of Washington, Inc (NPI 1659897163, Bothell, WA) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** May 12, 2021
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Source: [NPI Profile](https://npiprofile.com/npi/1477137693) · Data from the CMS NPPES public registry.