Active NPI
Christopher Blake Ennis, ACNPC-AG
- Gerontology Nurse Practitioner
- Macon, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Nurse Practitioner
- License
- RN201532
- Practice address
- 777 Hemlock St
Macon, GA 31201-2102 - Phone
- (478) 633-6272
- Fax
- (478) 633-6269
- NPI assigned
- Sep 30, 2016
- 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 |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | RN201532 | GA | Primary |
Addresses
Primary practice location
777 Hemlock St
Macon, GA 31201-2102
Mailing address
777 Hemlock St
Macon, GA 31201-2102
Phone (478) 633-6272
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
777 Hemlock St
Macon, GA 31201-2102
Phone (478) 633-1000
Hospital & facility affiliations
- Atrium Health Navicent the Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN201532 | GA | MD | Gerontology Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Health Services of Central Georgia, Inc | Current | Accepting new patients | |
| Northeast Georgia Heart Center | Current | Accepting new patients |
Locations
200 S Enota Dr NE
Ste 200
Gainesville, GA 30501
Phone (770) 534-0991
777 Hemlock St
Macon, GA 31201
Phone (478) 474-5600
1120 Morningside Dr
Perry, GA 31069
Phone (478) 218-1706
Interoperability endpoints
- cennis1221523@carolinashealthcaresystem.direct-ci.com
Organizations & group practices 2
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.
-
- Multi-Specialty Clinic/Center
- Macon, GA
- NPI 1184679482
-
- Cardiovascular Disease Physician
- Gainesville, GA
- NPI 1508812421
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Macon, GA
- NPI 1043270564
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1475193600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695168000000",
"number": "1740739853",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "777 HEMLOCK ST",
"city": "MACON",
"state": "GA",
"postal_code": "312012102",
"telephone_number": "478-633-6272",
"fax_number": "478-633-6269"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "777 HEMLOCK ST",
"city": "MACON",
"state": "GA",
"postal_code": "312012102",
"telephone_number": "478-633-6272",
"fax_number": "478-633-6269"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENNIS",
"first_name": "CHRISTOPHER",
"middle_name": "BLAKE",
"credential": "ACNPC-AG",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-09-30",
"last_updated": "2023-09-20",
"certification_date": "2023-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "GA",
"license": "RN201532",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Macon, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2023; 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.