Active NPI
Gregory Mark Ennis, M.D.
- Family Medicine Physician
- Gig Harbor, WA
National Provider Identifier
1245220672
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD60105263
- Practice address
- 6401 Kimball Dr
Gig Harbor, WA 98335-1228 - Phone
- (253) 858-9192
- Fax
- (253) 985-2853
- NPI assigned
- Oct 26, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD60105263 | WA | Primary |
Addresses
Primary practice location
6401 Kimball Dr
Gig Harbor, WA 98335-1228
Mailing address
6401 Kimball Dr
Gig Harbor, WA 98335-1228
Phone (253) 858-9192
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366539421 | Medicaid | WA | |
| 2040574 | Medicaid | WA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | gennis106516@fhsce.catholichealth.net | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD60105263 | WA | MD | Family Medicine Physician |
Interoperability endpoints
- gennis106516@fhsce.catholichealth.net
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606953600000",
"number": "1245220672",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6401 KIMBALL DR",
"city": "GIG HARBOR",
"state": "WA",
"postal_code": "983351228",
"telephone_number": "253-858-9192",
"fax_number": "253-985-2853"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6401 KIMBALL DR",
"city": "GIG HARBOR",
"state": "WA",
"postal_code": "983351228",
"telephone_number": "253-858-9192",
"fax_number": "253-985-2853"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENNIS",
"first_name": "GREGORY",
"middle_name": "MARK",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-26",
"last_updated": "2020-12-03",
"certification_date": "2020-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WA",
"license": "MD60105263",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1366539421",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2040574",
"state": "WA"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "gennis106516@fhsce.catholichealth.net",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "6401 Kimball Dr",
"city": "Gig Harbor",
"state": "WA",
"country_code": "US",
"postal_code": "983351228",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Gig Harbor, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.