Active NPI
Ennis Physical Medicine, PLLC
- General Practice Physician
- Ennis, TX
National Provider Identifier
1316439201
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- K5597
- Legal business name
- ENNIS PHYSICAL MEDICINE, PLLC
- Practice address
- 109 NW Main St Ste B
Ennis, TX 75119-4079 - Phone
- (972) 293-9355
- Fax
- (915) 206-5076
- NPI assigned
- Jun 5, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. William Cameron Davis, DC
- Title
- Clinic Director
- Phone
- (972) 293-9355
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | K5597 | TX | Primary |
Addresses
Primary practice location
109 NW Main St Ste B
Ennis, TX 75119-4079
Mailing address
109 NW Main St Ste B
Ennis, TX 75119-4079
Phone (972) 293-9355
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180920001863 | TX | Part B Supplier - Clinic/Group Practice | 2668723263 |
Receives reassigned benefits from 3 practitioners Practice locations: Ennis, TX |
National Provider Directory
National Provider DirectoryLocations
109 NW Main St
Ste B
Ennis, TX 75119
Phone (972) 293-9355
Practitioners & affiliated clinicians
Practitioners 4
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Ennis, TX
- NPI 1306890645
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528156800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1528156800000",
"number": "1316439201",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "109 NW MAIN ST STE B",
"city": "ENNIS",
"state": "TX",
"postal_code": "751194079",
"telephone_number": "972-293-9355"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 NW MAIN ST STE B",
"city": "ENNIS",
"state": "TX",
"postal_code": "751194079",
"telephone_number": "972-293-9355",
"fax_number": "915-206-5076"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ENNIS PHYSICAL MEDICINE, PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2018-06-05",
"last_updated": "2018-06-05",
"status": "A",
"authorized_official_last_name": "DAVIS",
"authorized_official_first_name": "WILLIAM",
"authorized_official_middle_name": "CAMERON",
"authorized_official_title_or_position": "CLINIC DIRECTOR",
"authorized_official_telephone_number": "972-293-9355",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "DC"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "General Practice",
"state": "TX",
"license": "K5597",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ennis, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.