James P. Ennis II, PA-C
Individual provider Active NPI Surgical Physician Assistant · Phoenix, MD
NPI 1598047367 · NPPES record last updated Sep 16, 2011
Key facts
- NPI
- 1598047367
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgical Physician Assistant 363AS0400X
- Practice address
- 4023 Cloverland Drive
Phoenix, MD 21131-2139 - Phone
- (443) 514-5864
- Fax
- (410) 420-9641
- NPI assigned
- Sep 16, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20131210000112 | MD | Practitioner - Physician Assistant | 4082841556 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Radiology P a | Current |
Accepting new patients | |
| Advanced Radiology P a | Current |
Accepting new patients | |
| Frederick Health Hospital Inc | Past | Accepting new patients |
Locations
26999 Network Pl
Chicago, IL 60673
500 Upper Chesapeake Dr
Bel Air, MD 21014
Phone (443) 643-1000
4801 Dorsey Hall Dr
Ste 101
Ellicott City, MD 21042
Phone (443) 436-1600
7253 Ambassador Rd
Windsor Mill, MD 21244
Phone (410) 281-9191
Interoperability endpoints
- jennis102486@direct.umm.edu
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | Yes |
Addresses
Primary practice location
4023 Cloverland Drive
Phoenix, MD 21131-2139
Mailing address
4023 Cloverland Drive
Phoenix, MD 21131-2139
Phone (443) 514-5864
Other providers in Phoenix, MD
- Michael F Diffendall
- Dr Alan R Scharf DDS LLC
- Dr. Maria Yiassemides, P.a.
- Joan Patricia Edwards
- Riley Elmer
- Family Foot and Ankle Care, PC
- Family Foot and Ankle Care, PC
- Magdalena Felton
- Kerry Elisabeth Fitzpatrick
- April Christine Fogg
All providers in Phoenix, MD · Surgical Physician Assistant in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 16, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.