NPIMap

Individual provider Active NPI

Andrew Kenneth Etzel, DO

  • Internal Medicine Physician
  • Wheeling, WV
National Provider Identifier
1013143742
Registry record updated Aug 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2251 Issued in WV
Practice address
2115 Chapline St
Wheeling, WV 26003-3859
Phone
(304) 234-8885
NPI assigned
Jun 9, 2009
Last updated
Aug 12, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 12, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2251 WV Primary

Addresses

Primary practice location

2115 Chapline St
Wheeling, WV 26003-3859

Mailing address

109 Mount Wood Rd
Wheeling, WV 26003-2632
Phone (304) 234-2455

Other identifiers 3

IdentifierTypeStateIssuer
3810015261MedicaidWV
P00960914OtherWVRAILROAD MEDICARE PIN
2967768MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160824000301 PA Practitioner - Internal Medicine 8729134200 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
West Virginia School of Osteopathic Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Pittsburgh PhysiciansGroup PAC ID 8729990239, 4,166 clinicians

Practice addresses (Care Compare)

200 Lothrop St
Pittsburgh, PA 15213-2546
Phone (412) 383-1370

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University of Pittsburgh Physicians CurrentSince Jul 1, 2024 Accepting new patients
University of Pittsburgh Physicians Current Accepting new patients
University of Pittsburgh Physicians CurrentSince Jul 1, 2024 Accepting new patients
Upmc Greene Past Accepting new patients
Upmc Greene Past Accepting new patients

Locations

200 Lothrop St
Pittsburgh, PA 15213
Phone (412) 647-3553

Organizations & group practices 6

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1244505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376265600000",
    "number": "1013143742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 MOUNT WOOD RD",
            "city": "WHEELING",
            "state": "WV",
            "postal_code": "260032632",
            "telephone_number": "304-234-2455",
            "fax_number": "304-233-6073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2115 CHAPLINE ST",
            "city": "WHEELING",
            "state": "WV",
            "postal_code": "260033859",
            "telephone_number": "304-234-8885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETZEL",
        "first_name": "ANDREW",
        "middle_name": "KENNETH",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-06-09",
        "last_updated": "2013-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WV",
            "license": "2251",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810015261",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "P00960914",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2967768",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wheeling, WV

Sources for this page

Verify at the official NPI Registry.