Nadine Angela Ennis, P.A.C.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

004493 Issued in GA

Practice address

3620 Martin Luther King Jr Dr SW
Atlanta, GA 30331-3711

Phone

(404) 696-7300

Fax

(404) 699-3514

NPI assigned

Nov 7, 2006

Last updated

Sep 27, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southwest Atlanta Nephrology, PCGroup PAC ID 2062315088, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: nadine.ennis.1@16547.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southwest Atlanta Nephrology, PC

  • Nephrology Physician
  • Atlanta, GA
  • NPI 1992756894
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285545600000",
    "number": "1962571612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3620 MARTIN LUTHER KING JR DR SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303313711",
            "telephone_number": "404-696-7300",
            "fax_number": "404-699-3514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3620 MARTIN LUTHER KING JR DR SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303313711",
            "telephone_number": "404-696-7300",
            "fax_number": "404-699-3514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENNIS",
        "first_name": "NADINE",
        "middle_name": "ANGELA",
        "name_prefix": "Ms.",
        "credential": "P.A.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-07",
        "last_updated": "2010-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "004493",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "457877647A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "457877647C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "457877647D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "457877647E",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "457877647B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Valerie L English, WHNP
• Vanessa Daniel English
• Christine Alicia Engstrom, MS,RDN,LDN
• Linda Enjema
• Cleveland J Enmon, M.D.
• Ennoble Hospice Atlanta LLC
• Eric Ennuson, DDS
• Ina L Enoch, PH.D.
• Tansha Enoch, PMHNP
• Nosayaba Enofe, M.D

• Medical Physician Assistant in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Medical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2010; 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.