Tara Rexanne Ennis, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

ME121048 Issued in FL

Practice address

1042 Mar Walt Dr
Fort Walton Beach, FL 32547-6645

Phone

(850) 863-0400

Fax

(850) 863-0417

NPI assigned

Oct 26, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Tara Rexanne Harden Former name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

General Surgery

Education

University of Alabama School of Medicine, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Florida Surgeons PAGroup PAC ID 2769381391, 336 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• HCA Florida Fort Walton-Destin Hospital Hospital, Fort Walton Beach, FL, CCN 100223
• HCA Florida Twin Cities Hospital Hospital, Niceville, FL, CCN 100054

Merit-based Incentive Payment System (MIPS)

Final score

86.32 of 100Reported as individual

Quality

75.67

Promoting interoperability

99

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tara.ennis.1@9109.direct.athenahealth.com

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.

• North Florida Surgeons, PA

  • Surgery Physician
  • Jacksonville, FL
  • NPI 1912953290
  Medicare reassignment Care Compare group NPD
• North Florida Surgeons, PA

  • Orthopaedic Surgery Physician
  • Gulf Breeze, FL
  • NPI 1871442053
  NPD
• Alteon Health Alabama, LLC

  • Emergency Medicine Physician
  • Talladega, AL
  • NPI 1477708857
  NPD (past)
• Andalusia Physician Practices LLC

  • Family Medicine Physician
  • Andalusia, AL
  • NPI 1972870335
  NPD (past)
• McKowen & Day MD PC

  • Specialist
  • Andalusia, AL
  • NPI 1497891741
  NPD (past)

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

• Fort Walton Beach Medical Center, Inc.

  • General Acute Care Hospital
  • Ft Walton Beach, FL
  • NPI 1639128820
  Care Compare affiliation
• Okaloosa Hospital Inc

  • General Acute Care Hospital
  • Niceville, FL
  • NPI 1891732988
  Care Compare affiliation

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625616000000",
    "number": "1700961141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1775 LEWIS TURNER BLVD",
            "address_2": "SUITE 101",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325471267",
            "telephone_number": "850-863-0400",
            "fax_number": "850-863-0417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1042 MAR WALT DR",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476645",
            "telephone_number": "850-863-0400",
            "fax_number": "850-863-0417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENNIS",
        "first_name": "TARA",
        "middle_name": "REXANNE",
        "name_prefix": "Ms.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-26",
        "last_updated": "2021-07-07",
        "certification_date": "2021-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AL",
            "license": "28214",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "ME121048",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "120202",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "M'CARE PROVIDER #",
            "identifier": "102I028400",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TARA",
            "last_name": "HARDEN",
            "middle_name": "REXANNE",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Ryann Vanessa Ennis, SPEECH/LANGUAGE PATH
• Epifani LLC
• Sara Kelly Erdwins, PA-C
• David Alan Erickson, MD
• Samantha Ervin, APRN
• Tracie Esmond, LCSW

• Surgery Physician in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.