NPIMap

Individual provider Active NPI

Bruce Martin Ennis, M.D.

  • Interventional Cardiology Physician
  • Mandeville, LA
National Provider Identifier
1639134901
Registry record updated Apr 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
201758 Issued in LA
Practice address
675 N Causeway Blvd
Mandeville, LA 70448-4600
Phone
(985) 200-3530
Fax
(985) 202-2010
NPI assigned
Apr 19, 2006
Last updated
Apr 12, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 12, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 201758 LA
Cardiovascular Disease Physician 207RC0000X 201758 LA
Interventional Cardiology Physician 207RI0011X 201758 LA Primary

Addresses

Primary practice location

675 N Causeway Blvd
Mandeville, LA 70448-4600

Mailing address

675 N Causeway Blvd
Mandeville, LA 70448-4600
Phone (985) 200-3530

Other practice location 1

15813 Medical Center Dr.
Suite#403
Hammond, LA 70403
Phone (985) 230-7368

Other identifiers 3

IdentifierTypeStateIssuer
2432401MedicaidLA
1973025MedicaidLA
31725ZYJTOtherLAMEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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
I20101116001119 LA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 4486686318 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Oaks Medical Center LLCGroup PAC ID 2466629522, 317 clinicians
North Shore Heart and Vascular LLCGroup PAC ID 5193008290, 2 clinicians
Cardiovascular Specialty Care Center of Covington, LLCGroup PAC ID 2365717139, 8 clinicians

Practice addresses (Care Compare)

15813 Paul Vega MD Dr
Suite 403
Hammond, LA 70403-1426
Phone (985) 230-7350

675 N Causeway Blvd
Mandeville, LA 70448-4600
Phone (985) 200-3530

71070 Hwy 21
Covington, LA 70433-7160
Phone (225) 456-5383

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.91 of 100Reported as group
Quality
78.17
Promoting interoperability
100
Improvement activities
40
Cost
67.71

Merit-based Incentive Payment System (MIPS)

Final score
84.36 of 100Reported as group
Quality
74.29
Promoting interoperability
100
Improvement activities
40
Cost
68.18

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting25
Pacemaker insertion or repair1-10
Varicose vein removal1-10
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
201758LAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cardiovascular Specialty Care Center of Covington, LLC Cardiovascular Disease CurrentSince Aug 28, 2017 Accepting new patients
North Shore Heart and Vascular, L.L.C. Cardiovascular Disease CurrentSince May 12, 2016 Accepting new patients
North Oaks Physician Group, LLC CurrentSince Sep 17, 2018 Accepting new patients
Cardiovascular Specialty Cath Center of Covington, LLC Cardiovascular Disease CurrentSince Jun 1, 2022 Accepting new patients
North Oaks Medical Center, LLC CurrentSince Jun 2, 2022 Accepting new patients
Houston Cardiovascular Consultants LLP Cardiovascular Disease Past Accepting new patients
Tchefuncte Cardiovascular Associates PastSince Oct 4, 2010 Accepting new patients

Locations

71070 Highway 21
Covington, LA 70433
Phone (225) 456-5383

15790 Paul Vega Md Dr
Hammond, LA 70403
Phone (985) 230-1682

15813 Paul Vega Md Dr
Hammond, LA 70403

15813 Paul Vega Md Dr
Ste 200
Hammond, LA 70403
Phone (985) 230-7650

15813 Paul Vega Md Dr
Ste 402
Hammond, LA 70403
Phone (985) 230-7350

15813 Paul Vega Md Dr
Ste 403
Hammond, LA 70403
Phone (985) 230-7350

675 N Causeway Blvd
Mandeville, LA 70448
Phone (985) 200-3530

Interoperability endpoints

  • Direct secure messaging: bruce.ennis.1@13800.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/13800/brand/1/csg/1/fhir/r4
  • FHIR API: https://api.platform.athenahealth.com/4385/brand/1/csg/1/fhir/r4

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1145404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681257600000",
    "number": "1639134901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 N CAUSEWAY BLVD",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704484600",
            "telephone_number": "985-200-3530",
            "fax_number": "985-202-2010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 N CAUSEWAY BLVD",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704484600",
            "telephone_number": "985-200-3530",
            "fax_number": "985-202-2010"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15813 Medical Center Dr.",
            "address_2": "Suite#403",
            "address_purpose": "LOCATION",
            "city": "Hammond",
            "state": "LA",
            "postal_code": "70403",
            "country_code": "US",
            "telephone_number": "985-230-7368",
            "fax_number": "985-230-7352",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ENNIS",
        "first_name": "BRUCE",
        "middle_name": "MARTIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-19",
        "last_updated": "2023-04-12",
        "certification_date": "2023-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "201758",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "LA",
            "license": "201758",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "LA",
            "license": "201758",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2432401",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1973025",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "31725ZYJT",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mandeville, LA

Sources for this page

Verify at the official NPI Registry.