NPIMap

Individual provider Active NPI

Jared Ennis, MD

  • Interventional Pain Medicine Physician
  • Fayetteville, AR
National Provider Identifier
1467539155
Registry record updated Mar 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
E-4271 Issued in AR
Practice address
4019 N Remington Dr
Fayetteville, AR 72703-6344
Phone
(479) 595-8192
Fax
(479) 442-1748
NPI assigned
Nov 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine Physician 208VP0014X E-4271 AR Primary
Anesthesiology Physician 207L00000X E-4271 AR

Addresses

Primary practice location

4019 N Remington Dr
Fayetteville, AR 72703-6344

Mailing address

4019 N Remington Dr
Fayetteville, AR 72703-6344
Phone (479) 595-8192

Other identifiers 1

IdentifierTypeStateIssuer
157891001MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050627001203 AR Practitioner - Interventional Pain ManagementPractitioner - Anesthesiology 3476598756 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional Pain Management
Education
University of Arkansas College of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Interventional Pain Specialists of Nwa PLLCGroup PAC ID 6901081538, 2 clinicians

Practice addresses (Care Compare)

4019 N Remington Dr
Fayetteville, AR 72703-6344
Phone (479) 595-8192

Hospital & facility affiliations

  • Northwest Medical Center-Springdale Hospital, Springdale, AR, CCN 040022
  • Washington Regional Medical Center Hospital, Fayetteville, AR, CCN 040004
  • Mercy Hospital Northwest Arkansas Hospital, Rogers, AR, CCN 040010
  • Siloam Springs Regional Hospital Hospital, Siloam Springs, AR, CCN 040001
  • Mercy Hospital Fort Smith Hospital, Fort Smith, AR, CCN 040062

Merit-based Incentive Payment System (MIPS)

Final score
21.27 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
70.91

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
E-4271ARMDInterventional Pain Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Natural State Counseling Centers CurrentSince Sep 1, 2024 Accepting new patients
Interventional Pain Specialists of Nwa, PLLC Interventional Pain Medicine CurrentSince Apr 1, 2011 Accepting new patients
Chase Placek Floyd Meggers Anesthesiology PastSince Jun 1, 2011 Accepting new patients
Northeast Arkansas Clinic Charitable Foundation, Inc. Anesthesiology Past Accepting new patients

Locations

4019 N Remington Dr
Fayetteville, AR 72703
Phone (479) 595-8192

509 E Millsap Rd
Ste 109
Fayetteville, AR 72703
Phone (479) 595-8192

Interoperability endpoints

  • Direct secure messaging: interventionalpainspecialists.jaredennis@120973.advancedmd-direct.com

Organizations & group practices 4

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680048000000",
    "number": "1467539155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4019 N REMINGTON DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727036344",
            "telephone_number": "479-595-8192",
            "fax_number": "479-442-1748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4019 N REMINGTON DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727036344",
            "telephone_number": "479-595-8192",
            "fax_number": "479-442-1748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENNIS",
        "first_name": "JARED",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2023-03-29",
        "certification_date": "2023-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "AR",
            "license": "E-4271",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "AR",
            "license": "E-4271",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "157891001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

Verify at the official NPI Registry.