Active NPI
Gregory G Ennis, M.D.
- Physical Medicine & Rehabilitation Physician
- Evansville, IN
National Provider Identifier
1780783183
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- 01051903A
- Practice address
- 4100 Covert Ave
Evansville, IN 47714-5559 - Phone
- (812) 476-9983
- Fax
- (812) 476-3809
- NPI assigned
- Sep 22, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | 01051903A | IN | Primary |
Addresses
Primary practice location
4100 Covert Ave
Evansville, IN 47714-5559
Mailing address
PO Box 3276
Evansville, IN 47731-3276
Phone (812) 473-0181
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 610186900 | Other | IN | FECA PIN |
| 610186900 | Other | IN | BLACK LUNG PIN |
| 64003460 | Medicaid | KY | |
| 145885 | Other | IN | UMWA PIN |
| 423127 | Other | IN | HEALTHLINK NONPAR PIN |
| 1761906 | Other | IN | FIRST HEALTH PIN |
| 064756 | Other | IN | HAMP PIN |
| 000000078150 | Other | IN | BCBS PIN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01051903A | IN | MD | Physical Medicine & Rehabilitation Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1303257600000",
"number": "1780783183",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3276",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477313276",
"telephone_number": "812-473-0181",
"fax_number": "812-473-5822"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4100 COVERT AVE",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477145559",
"telephone_number": "812-476-9983",
"fax_number": "812-476-3809"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENNIS",
"first_name": "GREGORY",
"middle_name": "G",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-22",
"last_updated": "2011-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "IN",
"license": "01051903A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FECA PIN",
"identifier": "610186900",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLACK LUNG PIN",
"identifier": "610186900",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64003460",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UMWA PIN",
"identifier": "145885",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK NONPAR PIN",
"identifier": "423127",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST HEALTH PIN",
"identifier": "1761906",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HAMP PIN",
"identifier": "064756",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PIN",
"identifier": "000000078150",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Evansville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.