Active NPI
Ethan J Musgrave, M.D.
- Child & Adolescent Psychiatry Physician
- Cincinnati, OH
National Provider Identifier
1003023060
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- 35.090109
- Practice address
- 3333 Burnet Ave
ML 3014
Cincinnati, OH 45229-3039 - Phone
- (513) 636-4788
- Fax
- (513) 636-4283
- NPI assigned
- May 17, 2007
- 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 |
|---|---|---|---|---|
| Child & Adolescent Psychiatry Physician | 2084P0804X | 35.090109 | OH | Primary |
Addresses
Primary practice location
3333 Burnet Ave
ML 3014
Cincinnati, OH 45229-3039
Mailing address
3333 Burnet Ave
ML 5012
Cincinnati, OH 45229-3039
Phone (513) 636-8069
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Oct 1, 2018 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35.090109 | OH | MD | Child & Adolescent Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209340800000",
"number": "1003023060",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3333 BURNET AVE",
"address_2": "ML 5012",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452293039",
"telephone_number": "513-636-8069",
"fax_number": "513-636-4272"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3333 BURNET AVE",
"address_2": "ML 3014",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452293039",
"telephone_number": "513-636-4788",
"fax_number": "513-636-4283"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUSGRAVE",
"first_name": "ETHAN",
"middle_name": "J",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-17",
"last_updated": "2008-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "OH",
"license": "35.090109",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cincinnati, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2008; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.