Wash hands with soap and water.
In a large oven-proof skillet over medium-high heat, add the Italian chicken sausage, breaking it up into pieces.
Wash hands with soap and water after handling raw sausage.
Cook until browned and cook until it reaches 165 °F on a digital food thermometer, about 5 minutes. Drain excess fat. Stir in ¼ cup of pepperoni and cook for 1 minute.
Wash hands with soap and water after handling pepperoni.
Preheat oven to broil.
To the skillet, stir in the salt, oregano, basil, garlic powder and red pepper flakes. Allow to cook for 30 seconds.
Add tomato sauce, water, and pasta. Stir well to combine. Bring to a boil. Cover, reduce heat and simmer until pasta is cooked, about 12 to 14 minutes.
Remove from the heat and top with shredded mozzarella and remaining ¼ cup of pepperoni. Place under the broiler and cook until melted and golden brown, about 2 minutes.
Garnish with fresh basil and serve immediately.