Active NPI
James R Ennis, DO
- General Practice Physician
- Holts Summit, MO
National Provider Identifier
1881666865
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- R6639
- Practice address
- 180 Northstar
Holts Summit, MO 65043 - Phone
- (573) 896-5115
- Fax
- (573) 896-4272
- NPI assigned
- Feb 3, 2006
- 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 |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | R6639 | MO | Primary |
Addresses
Primary practice location
180 Northstar
Holts Summit, MO 65043
Mailing address
180 Northstar
Capital Region Medical Clinic
Holts Summit, MO 65043
Phone (573) 896-5115
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 813149 | Other | FIRST HEALTH | |
| 104257 | Other | HEALTHLINK | |
| 100491 | Other | BLUE CROSS BLUE SHIELD | |
| 7779636 | Other | CIGNA | |
| 240009803 | Medicaid | MO | |
| 501607808 | Medicaid | MO |
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 Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138924800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1342656000000",
"number": "1881666865",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "180 NORTHSTAR",
"address_2": "CAPITAL REGION MEDICAL CLINIC",
"city": "HOLTS SUMMIT",
"state": "MO",
"postal_code": "65043",
"telephone_number": "573-896-5115",
"fax_number": "573-896-4272"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "180 NORTHSTAR",
"city": "HOLTS SUMMIT",
"state": "MO",
"postal_code": "65043",
"telephone_number": "573-896-5115",
"fax_number": "573-896-4272"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENNIS",
"first_name": "JAMES",
"middle_name": "R",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-03",
"last_updated": "2012-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "MO",
"license": "R6639",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST HEALTH",
"identifier": "813149",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "104257",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "100491",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "7779636",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "240009803",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "501607808",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Holts Summit, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.