MS. TARA REXANNE ENNIS (MD) – Surgery Physician, NPI 1700961141
Surgery Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
2,166 GENERAL SURGERY in FL
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Provider Addresses for MS. TARA REXANNE ENNIS (MD)
1775, Lewis Turner Boulevard, Fort Walton Beach, Okaloosa County, Florida, 32547, United States
SUITE 101
FORT WALTON BEACH, FL 325471267
Phone: (850) 863-0400
Fax: (850) 863-0417
Type: Location
1042 MAR WALT DR
FORT WALTON BEACH, FL 325476645
Phone: (850) 863-0400
Fax: (850) 863-0417
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 13 Open Payments records for all available years, with a total value of $2,457.
Total Amount is formed as General ($2,457) + Research ($0) + Ownership ($0) = $2,457.
Last reported payment date: 2024-09-04 • Largest payer in this snapshot: Medical Device Business Services, Inc. ($909).
Total Amount
$2,457
General + Research + Ownership
Payments
13
Total payment records
General Amount
$2,457
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-09-04
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Medical Device Business Services, Inc. | $909 |
| Intuitive Surgical, Inc. | $795 |
| Nexxt Spine LLC | $736 |
| Solventum Corporation | $17 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2015-01-06
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20150106001355 | I | General Surgery | FL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 72 | 53 | $0 |
| 99203 | New patient office or other outpatient visit, 30-44 minutes | 59 | 59 | $0 |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 47 | 47 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 37 | 35 | $0 |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | 24 | 24 | $0 |
Insurance plans in this area (ZIP 32547)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| O T O L A R Y N G O L O G Y | PA | |
| Otolaryngology, General Surgery | FL | |
| O T O L A R Y N G O L O G Y | KY | |
| General Surgery, Critical Care (Intensivists) | FL | |
| Orthopedic Surgery | FL | |
| Otolaryngology, Sleep Medicine | FL | |
| General Surgery | FL | |
| General Surgery | FL | |
| O P H T H A L M O L O G Y | FL | |
| Pain Management | FL |
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