Ethan James, MAT, ATC

Primary specialty

Prevention ProfessionalTaxonomy code 405300000X

License

36002454A Issued in IN

Practice address

515 Read St
Evansville, IN 47710-1739

Phone

(812) 424-9291

Fax

(812) 421-2722

NPI assigned

Feb 1, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1485907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485907200000",
    "number": "1134667900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 CASTLE CMNS",
            "address_2": "UNIT C",
            "city": "NEWBURGH",
            "state": "IN",
            "postal_code": "476307108",
            "telephone_number": "937-206-3960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 READ ST",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477101739",
            "telephone_number": "812-424-9291",
            "fax_number": "812-421-2722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAMES",
        "first_name": "ETHAN",
        "credential": "MAT, ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-02-01",
        "last_updated": "2017-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "405300000X",
            "taxonomy_group": "",
            "desc": "Prevention Professional",
            "state": "IN",
            "license": "36002454A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF INDIANA",
            "identifier": "36002454A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• James R Gill DDS MSD Inc PC
• Amber Jo James, D.C.
• Ashley N James, NP
• Hannah James
• Jeffrey Lynn James, D.C.
• Joseph S. James, D.C.
• Suzanne James, PT
• Wendy James, MSW LCSW

• Prevention Professional in Evansville, IN
• Providers in Evansville, IN by specialty
• Prevention Professional in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.