Ethan Alcide Simoneau, DPM

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

PR541 Issued in FL

Practice address

10000 Bay Pines Blvd
Bay Pines, FL 33744-8200

Phone

(727) 398-6661

NPI assigned

Aug 19, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1503100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1503100800000",
    "number": "1124544382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1560 CENTRAL AVE UNIT 356",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337051623",
            "telephone_number": "603-630-5851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10000 BAY PINES BLVD",
            "city": "BAY PINES",
            "state": "FL",
            "postal_code": "337448200",
            "telephone_number": "727-398-6661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMONEAU",
        "first_name": "ETHAN",
        "middle_name": "ALCIDE",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-19",
        "last_updated": "2017-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "FL",
            "license": "PR541",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Colleen Marie Shushtari, R.D.,L.D.
• Stuart Neil Sidell, MS,CAS,CTRS
• Julia Sikorski
• Maria Auxiliadora Silva, DSW, LCSW
• Elizabeth Simoes, ARNP
• Stephanie Suzanne Singer, DO
• Barbara Sinni-McKeehen, ARNP
• Ryan Skale, D.D.S.
• David Lewis Slack, PH.D.
• Bonnie Slade, CPHT

• Foot & Ankle Surgery Podiatrist in Bay Pines, FL
• Providers in Bay Pines, FL by specialty
• Foot & Ankle Surgery Podiatrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.