NPIMap

Individual provider Active NPI

Brent A Enniss, DO

  • Anatomic Pathology & Clinical Pathology Physician
  • Aurora, CO
National Provider Identifier
1558709352
Registry record updated Nov 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
DR.0068949 Issued in CO
Practice address
1455 S Potomac St Ste 101
Aurora, CO 80012-4501
Phone
(303) 695-2635
Fax
(303) 873-5660
NPI assigned
Jun 13, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 1, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Blood Banking & Transfusion Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ZB0001X 1337 NE
General Practice Physician 208D00000X BP10048437 TX
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X DR.0068949 CO Primary

Addresses

Primary practice location

1455 S Potomac St Ste 101
Aurora, CO 80012-4501

Mailing address

PO Box 744326
Atlanta, GA 30374-4326
Phone (303) 695-2635

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20220627002467 CO Practitioner - Pathology 2860738655 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Elevated Pathology PLLCGroup PAC ID 8729433198, 6 clinicians

Practice addresses (Care Compare)

2350 Meadows Blvd
Castle Rock, CO 80109-8405
Phone (720) 455-5000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
BP10048437TXMDGeneral Practice Physician
1337NEMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Elevated Pathology PLLC Single Specialty CurrentSince Sep 1, 2024 Accepting new patients
Elevated Pathology PLLC Single Specialty CurrentSince Sep 1, 2024 Accepting new patients
Healthone Irl Pathology Services, LLC Single Specialty Past Accepting new patients

Locations

2350 Meadows Blvd
Castle Rock, CO 80109
Phone (720) 248-3413

2525 S Downing St
Denver, CO 80210
Phone (303) 744-2706

7700 S Broadway
Littleton, CO 80122
Phone (303) 269-4786

100 Health Park Dr
Louisville, CO 80027
Phone (303) 673-1000

9395 Crown Crest Blvd
Parker, CO 80138
Phone (303) 269-4000

5700 Southwyck Blvd
Toledo, OH 43614

Organizations & group practices 3

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 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1371081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667260800000",
    "number": "1558709352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 744326",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303744326",
            "telephone_number": "303-695-2635",
            "fax_number": "303-873-5660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1455 S POTOMAC ST STE 101",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800124501",
            "telephone_number": "303-695-2635",
            "fax_number": "303-873-5660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENNISS",
        "first_name": "BRENT",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-06-13",
        "last_updated": "2022-11-01",
        "certification_date": "2022-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZB0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Blood Banking & Transfusion Medicine",
            "state": "NE",
            "license": "1337",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "TX",
            "license": "BP10048437",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CO",
            "license": "DR.0068949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aurora, CO

Sources for this page

Verify at the official NPI Registry.