Philip Miracle Ennin Jr., APRN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

14447 Issued in CT

Practice address

269 Farmington Ave
Plainville, CT 06062-1335

Phone

(860) 655-2432

NPI assigned

Nov 20, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

HDC Care Solutions LLCGroup PAC ID 0345634770, 190 clinicians

Charter Oak Health Center, IncGroup PAC ID 3870401078, 37 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• HDC Care Solutions, LLC

  • Nurse Practitioner
  • Framingham, MA
  • NPI 1033861349

  CT

  Medicare reassignment Care Compare group NPD
• Charter Oak Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Hartford, CT
  • NPI 1992750855
  Medicare reassignment Care Compare group
• Careconnectmd Connecticut PC

  • Geriatric Medicine (Internal Medicine) Physician
  • Stamford, CT
  • NPI 1467187336
  Medicare reassignment NPD
• Value Based Long Term Care H PC

  • Geriatric Medicine (Internal Medicine) Physician
  • Framingham, MA
  • NPI 1134951676

  CT

  Medicare reassignment NPD

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

{
    "created_epoch": "1732060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740441600000",
    "number": "1124843503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 GORDON LN",
            "city": "EAST HARTFORD",
            "state": "CT",
            "postal_code": "061182222",
            "telephone_number": "860-655-2432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "269 FARMINGTON AVE",
            "city": "PLAINVILLE",
            "state": "CT",
            "postal_code": "060621335",
            "telephone_number": "860-655-2432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENNIN",
        "first_name": "PHILIP",
        "middle_name": "MIRACLE",
        "name_suffix": "Jr.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-11-20",
        "last_updated": "2025-02-25",
        "certification_date": "2025-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CT",
            "license": "164301",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CT",
            "license": "14447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Ellison, MSW
• Elizabeth Anne Ellsworth, MS, BCBA
• Terren M Emery, LMSW
• Desiree Emirzian, LCSW
• Empowering Lives Counseling LLC
• Jamie Erickson
• Amber C. Estelle
• Madeline Etter
• Kirsten Megan Evans
• Justin Richard Eykelhoff

• Nurse Practitioner in Plainville, CT
• Providers in Plainville, CT by specialty
• Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2025; 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.