General and Vascular Surgery of Ennis PA

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

GENERAL AND VASCULAR SURGERY OF ENNIS PA

Practice address

802 W Lampasas St
Ennis, TX 75119-4500

Phone

(972) 878-4700

Fax

(972) 878-2238

NPI assigned

Nov 3, 2005

Organization subpart

No

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

Authorized official

Name

John M Sullivan, MDNPI 1336132117

Title

Owner

Phone

(972) 878-4700

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

• Baylor Surgicare at Ennis LLC

  • Ambulatory Surgical Clinic/Center
  • Ennis, TX
  • NPI 1992008965

  Member Of

  NPD member
• North Texas Health Alliance, LLC

  • Ambulatory Surgical Clinic/Center
  • Ennis, TX
  • NPI 1417120684

  Member Of

  NPD member

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John M Sullivan, MD

  • Surgery Physician
  • Ennis, TX
  • NPI 1336132117

  TX

  Medicare reassignment Authorized official

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

{
    "created_epoch": "1130976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718323200000",
    "number": "1679564124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 W LAMPASAS ST",
            "city": "ENNIS",
            "state": "TX",
            "postal_code": "751194500",
            "telephone_number": "972-878-4700",
            "fax_number": "972-878-2238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 W LAMPASAS ST",
            "city": "ENNIS",
            "state": "TX",
            "postal_code": "751194500",
            "telephone_number": "972-878-4700",
            "fax_number": "972-878-2238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENERAL AND VASCULAR SURGERY OF ENNIS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-03",
        "last_updated": "2024-06-14",
        "certification_date": "2024-06-14",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-878-4700",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "00266V",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "159614002",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joey R. Flores, FNPC
• Roger A Frost, CRNA
• Daphne D Fullerton, MD
• Daniel Frederick Gabriel, D.C.
• Darla D Gardner, MS, CCC-SLP
• George Kingsley, D.O., Inc.
• Gina Merin George, PA-C
• Rebecca Jane Gillentine, PTA
• Claire Gonzalez, FNP-C
• Kayla Graff, FNP-C

• All providers in Ennis, TX
• Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2024; 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.

Verify at the official NPI Registry.