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Individual provider Active NPI

Richard Thomas Ethridge, MD

  • Plastic and Reconstructive Surgery Physician
  • Fort Collins, CO
National Provider Identifier
1013108299
Registry record updated Jan 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
DR.0063642 Issued in CO
Practice address
1100 Poudre River Dr Unit a
Fort Collins, CO 80524-3557
Phone
(970) 484-6303
Fax
(704) 843-0369
NPI assigned
Aug 5, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 23, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic and Reconstructive Surgery Physician 2086S0122X DR.0063642 CO Primary
Plastic and Reconstructive Surgery Physician 2086S0122X M5152 TX

Addresses

Primary practice location

1100 Poudre River Dr Unit a
Fort Collins, CO 80524-3557

Mailing address

151 Southhall LN Ste 300
Maitland, FL 32751-7172
Phone (970) 484-6303

Other identifiers 1

IdentifierTypeStateIssuer
768289543OtherMYUTMB 768289543

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, CO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080930000812 TX Practitioner - Plastic and Reconstructive Surgery 7618045808 Practice locations: Fort Worth, TX
I20200116002026 CO Practitioner - Plastic and Reconstructive Surgery 7618045808 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
University of Texas Medical Branch at Galveston, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Dermatology of Colorado PCGroup PAC ID 8325337330, 65 clinicians

Practice addresses (Care Compare)

1100 Poudre River Dr
Unit a
Fort Collins, CO 80524-3557
Phone (970) 484-3050

Hospital & facility affiliations

  • Poudre Valley Hospital Hospital, Fort Collins, CO, CCN 060010

Merit-based Incentive Payment System (MIPS)

Final score
82.78 of 100Reported as group
Quality
80
Promoting interoperability
84
Improvement activities
40
Cost
75.92

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision443
Removal of tissue1-10
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
DR.0063642COMDPlastic and Reconstructive Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Dermatology of Colorado, PC CurrentSince Mar 1, 2020 Accepting new patients

Locations

1100 Poudre River Dr
Unit A
Fort Collins, CO 80524
Phone (970) 484-3078

1006 Centre Ave
Fort Collins, CO 80526
Phone (970) 482-9001

1880 Fall River Dr
Ste 210
Loveland, CO 80538
Phone (970) 484-6303

2500 Rocky Mountain Ave
Ste 350
Loveland, CO 80538
Phone (970) 829-5535

151 Southhall Ln
Ste 300
Maitland, FL 32751
Phone (407) 917-7293

Networks

  • CO HMO D-SNP
  • CO HMO
  • devoted network organization-a4751131-f16f-4e82-8f2b-b08e66379a7a
  • NM HMO C-SNP

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1186272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579737600000",
    "number": "1013108299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 SOUTHHALL LN STE 300",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517172",
            "telephone_number": "970-484-6303",
            "fax_number": "970-484-3036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 POUDRE RIVER DR UNIT A",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805243557",
            "telephone_number": "970-484-6303",
            "fax_number": "704-843-0369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETHRIDGE",
        "first_name": "RICHARD",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-08-05",
        "last_updated": "2020-01-23",
        "certification_date": "2020-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "CO",
            "license": "DR.0063642",
            "primary": true
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "TX",
            "license": "M5152",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MYUTMB 768289543",
            "identifier": "768289543",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.