Active NPI
Enzo Jordan Lewis
- Physician Assistant
- Hurricane, WV
National Provider Identifier
1720858426
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- TC049
- Practice address
- 1124 Hickory Mills Rd
Hurricane, WV 25526-9056 - Phone
- (304) 881-1054
- NPI assigned
- Jan 3, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | TC049 | KY | Primary |
Addresses
Primary practice location
1124 Hickory Mills Rd
Hurricane, WV 25526-9056
Mailing address
1124 Hickory Mills Rd
Hurricane, WV 25526-9056
Phone (304) 881-1054
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1704240000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788134400000",
"number": "1720858426",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1124 HICKORY MILLS RD",
"city": "HURRICANE",
"state": "WV",
"postal_code": "255269056",
"telephone_number": "304-881-1054"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1124 HICKORY MILLS RD",
"city": "HURRICANE",
"state": "WV",
"postal_code": "255269056",
"telephone_number": "304-881-1054"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEWIS",
"first_name": "ENZO",
"middle_name": "JORDAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-01-03",
"last_updated": "2026-08-31",
"certification_date": "2026-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "KY",
"license": "TC049",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hurricane, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2026; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.