NPIMap

Individual provider Active NPI

John Laurent Etcheto, PA

  • Physician Assistant
  • Twin Falls, ID
National Provider Identifier
1073547113
Registry record updated May 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-476 Issued in ID
Practice address
176 Falls Avenue
Twin Falls, ID 83301
Phone
(208) 733-3181
Fax
(208) 733-3168
NPI assigned
Jul 11, 2006
Last updated
May 6, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA-476 ID Primary

Addresses

Primary practice location

176 Falls Avenue
Twin Falls, ID 83301

Mailing address

1740 Brookfield CT
Twin Falls, ID 83301-3562
Phone (208) 736-2399

Other practice location 1

260 2nd Avenue East
Twin Falls, ID 83301
Phone (208) 732-0959

Other identifiers 1

IdentifierTypeStateIssuer
806757300MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20040119000603 ID Practitioner - Physician Assistant 9436050788 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sipi Clinic LLCGroup PAC ID 5890167233, 6 clinicians

Practice addresses (Care Compare)

176 Falls Ave
Twin Falls, ID 83301-2306
Phone (208) 733-3181

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.09 of 100Reported as group
Quality
77.1
Promoting interoperability
100
Improvement activities
40
Cost
73.19

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA-476IDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Services Corporation CurrentSince Jul 7, 2006 Accepting new patients
Family Health Services Corporation CurrentSince Jul 7, 2006 Accepting new patients
Family Health Services Corporation Past Accepting new patients
Family Health Services Corporation Past Accepting new patients
Family Health Services Corporation Past Accepting new patients
St Luke's Magic Valley Regional Medical Center LTD Past Accepting new patients
Family Health Services Corporation Past Accepting new patients
Family Health Services Corporation Physician Assistant Past Accepting new patients
Family Health Services Pharmacy Past Accepting new patients
Family Health Services Corporation Physician Assistant Past Accepting new patients

Locations

725 Fair St
Buhl, ID 83316
Phone (208) 543-8271

1309 Bennett Ave
Burley, ID 83318
Phone (208) 677-5198

218 W Nez Perce
Jerome, ID 83338
Phone (208) 324-3471

402 6th St
Rupert, ID 83350
Phone (208) 650-7941

113 S Apple St
Shoshone, ID 83352
Phone (208) 886-2224

325 Martin St
Twin Falls, ID 83301
Phone (208) 732-7101

388 Martin St
Twin Falls, ID 83301
Phone (208) 734-0451

794 Eastland Dr
Twin Falls, ID 83301
Phone (208) 734-3312

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GHDGBD/Endpoint/GHDGBD

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 3

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": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714953600000",
    "number": "1073547113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1740 BROOKFIELD CT",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833013562",
            "telephone_number": "208-736-2399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "176 FALLS AVENUE",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "83301",
            "telephone_number": "208-733-3181",
            "fax_number": "208-733-3168"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "260 2nd Avenue East",
            "address_purpose": "LOCATION",
            "city": "Twin Falls",
            "state": "ID",
            "postal_code": "83301",
            "country_code": "US",
            "telephone_number": "208-732-0959",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ETCHETO",
        "first_name": "JOHN",
        "middle_name": "LAURENT",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-476",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806757300",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Twin Falls, ID

Sources for this page

Verify at the official NPI Registry.