NPIMap

Individual provider Active NPI

Ethan Newham, AGACNP-BC

  • Acute Care Nurse Practitioner
  • Richmond, VA
National Provider Identifier
1013524891
Registry record updated Oct 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
0024180239 Issued in VA
Practice address
1213 E Clay St
Richmond, VA 23298-5071
Phone
(804) 828-9000
NPI assigned
Sep 25, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 0024180239 VA Primary

Addresses

Primary practice location

1213 E Clay St
Richmond, VA 23298-5071

Mailing address

1213 E Clay St
Richmond, VA 23298-5071
Phone (800) 762-6161

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20210405001971 VA Practitioner - Nurse Practitioner 8123435344 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sound Physicians Intensivists of Virginia LLCGroup PAC ID 1759611411, 49 clinicians

Practice addresses (Care Compare)

200 Medical Park Blvd
Petersburg, VA 23805-9274
Phone (804) 765-5000

5801 Bremo Rd
Richmond, VA 23226-1907
Phone (804) 285-2011

8260 Atlee Rd
Mechanicsville, VA 23116-1844
Phone (804) 764-6000

Hospital & facility affiliations

  • Bon Secours St Marys Hospital Hospital, Richmond, VA, CCN 490059
  • Bon Secours Memorial Regional Medical Center Hospital, Mechanicsville, VA, CCN 490069
  • Bon Secours Southside Medical Center Hospital, Petersburg, VA, CCN 490067
  • Bon Secours St Francis Medical Center Hospital, Midlothian, VA, CCN 490136
  • Rappahannock General Hospital Hospital, Kilmarnock, VA, CCN 491308

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0024180239VAMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sound Physicians Intensivists of Virginia LLC CurrentSince Jan 1, 2022 Accepting new patients

Locations

5801 Bremo Rd
Richmond, VA 23226
Phone (804) 281-8220

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 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1600992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602633600000",
    "number": "1013524891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1213 E CLAY ST",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232985071",
            "telephone_number": "800-762-6161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1213 E CLAY ST",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232985071",
            "telephone_number": "804-828-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEWHAM",
        "first_name": "ETHAN",
        "credential": "AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-25",
        "last_updated": "2020-10-14",
        "certification_date": "2020-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "VA",
            "license": "0024180239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, VA

Sources for this page

Verify at the official NPI Registry.