Keith Ennis, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01040472A Issued in IN

Practice address

1907 W Sycamore St
Kokomo, IN 46901-5148

Phone

(765) 456-5433

NPI assigned

Oct 24, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Emergency MedicineAlso: Family Practice

Education

Indiana University School of Medicine, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Vincent Physician Services Hospital and Health Care CenterGroup PAC ID 9638072184, 276 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension St Vincent Kokomo Hospital, Kokomo, IN, CCN 150010
• Ascension St Vincent Hospital Hospital, Indianapolis, IN, CCN 150084
• St Vincent Kokomo Hospital Health Center Inpatient rehabilitation facility, Kokomo, IN, CCN 15T010

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: keith.ennis.1@7598.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• St Vincent Physician Services Hospital and Health Care Center

  • Family Medicine Physician
  • Indianapolis, IN
  • NPI 1669422234
  Medicare reassignment Care Compare group NPD
• St Vincent Physician Services Hospital and Health Care Center

  • Durable Medical Equipment & Medical Supplies
  • Carmel, IN
  • NPI 1366689044
  NPD
• American Health Network of Indiana, LLC

  • Family Medicine Physician
  • Mulberry, IN
  • NPI 1033220017
  NPD (past)
• Mesa Indiana Ed Associates, LLC

  • Emergency Medicine Physician
  • Lexington, KY
  • NPI 1003250473
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St. Joseph Hospital & Health Center, Inc.

  dba Ascension St. Vincent Kokomo

  • Rehabilitation Hospital Unit
  • Kokomo, IN
  • NPI 1508807272

  Inpatient rehabilitation facility

  Care Compare affiliation
• St. Joseph Hospital & Health Center, Inc.

  dba Ascension St. Vincent Kokomo

  • General Acute Care Hospital
  • Kokomo, IN
  • NPI 1780625442
  Care Compare affiliation
• St. Vincent Hospital & Health Care Center, Inc.

  dba Ascension St. Vincent Hospital

  • General Acute Care Hospital
  • Indianapolis, IN
  • NPI 1306898960
  Care Compare affiliation
• St. Vincent Hospital & Health Care Center, Inc.

  dba Ascension St. Vincent - Avon

  • General Acute Care Hospital
  • Avon, IN
  • NPI 1851833230
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655683200000",
    "number": "1033292628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1907 W SYCAMORE ST",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469015148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1907 W SYCAMORE ST",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469015148",
            "telephone_number": "765-456-5433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENNIS",
        "first_name": "KEITH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2022-06-20",
        "certification_date": "2022-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01040472A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200014450E",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "keith.ennis.1@7598.direct.athenahealth.com",
            "affiliation": "Y",
            "affiliationName": "ST VINCENT PHYSICIAN SERVICES HOSPITAL AND HEALTH CARE CENTER",
            "address_1": "1907 W Sycamore St",
            "city": "Kokomo",
            "state": "IN",
            "country_code": "US",
            "postal_code": "469015148",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Emergency Medicine Group of Kokomo, PC
• Natalie M Emert, M.D.
• Emgi - Howard, LLC
• Empowerme Rehabilitation Illinois, LLC
• Austin Engle, DDS
• Kristin Enoch, OT
• Marilyn Joanne Erb, HHA
• Cynthia Ann Erickson, R.D., C.D.
• Lou Erpelding
• Oluronke Deborah Esemomoh

• Family Medicine Physician in Kokomo, IN
• Providers in Kokomo, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.