NPIMap

Individual provider Active NPI

Daniel Kevin Ettlin, PA-C

  • Physician Assistant
  • Morrisville, NC
National Provider Identifier
1134770480
Registry record updated Sep 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
10950 Chapel Hill Rd
Morrisville, NC 27560-8852
Phone
(919) 425-3185
NPI assigned
Sep 26, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2019

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 Primary

Addresses

Primary practice location

10950 Chapel Hill Rd
Morrisville, NC 27560-8852

Mailing address

600 Saint Marys St Apt 340
Raleigh, NC 27605-1793

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20191223002376 NC Practitioner - Physician Assistant 7214361385 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Duke University School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Duke Health Integrated Practice IncGroup PAC ID 8325412737, 3,140 clinicians

Practice addresses (Care Compare)

1821 Hillandale Rd
Durham, NC 27705-2671
Phone (919) 684-8111

40 Duke Medicine Cir
Durham, NC 27710-4000
Phone (919) 684-8111

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Duke Health Integrated Practice, Inc. CurrentSince Jul 1, 2023 Accepting new patients
Duke University Affiliated Physicians, Inc. CurrentSince Dec 9, 2019 Accepting new patients
Duke Health Integrated Practice, Inc. CurrentSince Jul 1, 2023 Accepting new patients

Locations

1821 Hillandale Rd
Ste 25A
Durham, NC 27705
Phone (919) 620-7300

40 Duke Medicine Cir
Durham, NC 27710
Phone (919) 681-6588

1901 Hillandale Rd
Ste D
Durham, NC 27705
Phone (919) 383-4355

10950 Chapel Hill Rd
Morrisville, NC 27560
Phone (919) 327-1630

Interoperability endpoints

  • Direct secure messaging: dettlin406513@direct.medicine.duke.edu

Organizations & group practices 4

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 8

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": "1569456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569456000000",
    "number": "1134770480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 SAINT MARYS ST APT 340",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276051793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10950 CHAPEL HILL RD",
            "city": "MORRISVILLE",
            "state": "NC",
            "postal_code": "275608852",
            "telephone_number": "919-425-3185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETTLIN",
        "first_name": "DANIEL",
        "middle_name": "KEVIN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-26",
        "last_updated": "2019-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Morrisville, NC

Sources for this page

Verify at the official NPI Registry.