JACKIE IJEOMA PENN NP
NPI 1972940260
Nurse Practitioner - Psychiatric/Mental Health in Grand Prairie, TX
About Jackie Ijeoma Penn Np NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JACKIE IJEOMA PENN NP (NPI 1972940260) is an individual psychiatric/mental health provider in Grand Prairie, Texas, licensed in Texas (1056737) and active in the NPI registry since May 2013. She is enrolled in Medicare PECOS, is affiliated with Phs Indian Hospital At Rosebud, and is a graduate of Other (2021).
NPPES Registry Identity
Specialties & Licenses 2
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Jackie Ijeoma Penn Np is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
2Medicare enrollment records show Jackie Penn reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Rosebud, SD 57570
- Reassigned Medicare billing, Texas enrollment
- 386 clinicians in this Medicare group
Kyle, SD 57752
- Reassigned Medicare billing, Texas enrollment
- 84 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.
Hospital Affiliations CMS Care Compare
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Phs Indian Hospital At Rosebud
Acute Care Hospitals · Rosebud, SDPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 75052 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 Jackie Penn's NPI number?
The NPI number for Jackie Penn is 1972940260. It was assigned to this individual provider in the NPPES registry on May 28, 2013.
Where is Jackie Penn located?
Jackie Penn practices at 5319 Nueces Ln, Grand Prairie, TX 75052. The listed phone number is (214) 584-4103.
What is Jackie Penn's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.
Is Jackie Penn enrolled in Medicare?
Yes. Jackie Penn is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Jackie Penn's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jackie Penn reassigns Medicare benefits to 2 organizations: Rosebud Indian Health Service (Rosebud, SD) and Pine Ridge Indian Health Service Hospital (Kyle, SD). 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 Jackie Penn's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
Is Jackie Penn affiliated with any hospitals?
According to CMS data, Jackie Penn is affiliated with Phs Indian Hospital At Rosebud.
When was this NPI record last updated?
The NPPES record for Jackie Penn was last updated on May 3, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.
# Jackie Ijeoma Penn, NP · NPI 1972940260
Psychiatric/Mental Health physician in Grand Prairie, Texas. Individual provider, active in the CMS NPPES registry since May 28, 2013.
## Identity
- **NPI:** 1972940260 (Entity type: Individual)
- **Enumerated:** May 28, 2013
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **State license:** 1056737 (Texas)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 5319 NUECES LN, Grand Prairie, TX 75052-2667
- **Phone:** (214) 584-4103
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Rosebud Indian Health Service (NPI 1194757369, Rosebud, SD); Pine Ridge Indian Health Service Hospital (NPI 1003963497, Kyle, SD) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2021
## Record status
- **NPPES last updated:** May 3, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1972940260) · Data from the CMS NPPES public registry.