Randy M Ennen, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

N7403 Issued in AR

Practice address

3312 S 70TH St
Fort Smith, AR 72903-5052

Phone

(479) 452-7800

Fax

(479) 452-9486

NPI assigned

Mar 29, 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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Merit-based Incentive Payment System (MIPS)

Final score

97.46 of 100Reported as group

Quality

93.65

Improvement activities

40

Cost

100

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Executive Park Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Fort Smith, AR
  • NPI 1699736777
  NPD (past) Authorized official

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

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616025600000",
    "number": "1124089222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3312 S 70TH ST",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729035052",
            "telephone_number": "479-452-7800",
            "fax_number": "479-452-9486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3312 S 70TH ST",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729035052",
            "telephone_number": "479-452-7800",
            "fax_number": "479-452-9486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENNEN",
        "first_name": "RANDY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-29",
        "last_updated": "2021-03-18",
        "certification_date": "2021-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "AR",
            "license": "N7403",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114450001",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100177380A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Krista Rose England, LAC
• Lydia England, CNA
• Aaron Michael English, PA-C
• Sierra English, QBHP
• Ennen Eye Center, P.a.
• Elizabeth Renee Eoff, M.S., CCC-SLP
• Nicole Ervin, MHPP
• Heather Erwin, WHNP-BC
• Mayra Esquivel, MHPP
• Joseph Clint Estrada, PHARMD

• Ophthalmology Physician in Fort Smith, AR
• Providers in Fort Smith, AR by specialty
• Ophthalmology Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.