NPIMap

Individual provider Active NPI

Ethan Levine, D.O.

  • Clinical Cardiac Electrophysiology Physician
  • Elmira, NY
National Provider Identifier
1144238577
Registry record updated Jun 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X
License
221196 Issued in NY
Practice address
600 Roe Ave
Elmira, NY 14905-1629
Phone
(607) 735-4623
Fax
(607) 271-3711
NPI assigned
Aug 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Cardiac Electrophysiology Physician 207RC0001X 221196 NY Primary

Addresses

Primary practice location

600 Roe Ave
Elmira, NY 14905-1629

Mailing address

571 Saint Josephs Blvd FL 2
Elmira, NY 14901-3230
Phone (607) 271-2050

Other identifiers 2

IdentifierTypeStateIssuer
02886946MedicaidNY
102254461MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD, NE, WY3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20190801001480 SD Practitioner - Cardiac Electrophysiology 9537267273 Reassigns benefits to 1 organization
I20190820000640 NE Practitioner - Cardiovascular Disease (Cardiology) 9537267273 Reassigns benefits to 1 organization
I20191210001981 WY Practitioner - Cardiac Electrophysiology 9537267273 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiac Electrophysiology
Education
Lake Erie College of Osteopathic Medicine, Erie, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Monument Health Rapid City Hospital IncGroup PAC ID 6002729506, 560 clinicians

Practice addresses (Care Compare)

1303 N Lacrosse St
Rapid City, SD 57701-6956
Phone (605) 755-6600

1440 N Main St
Suite 100
Spearfish, SD 57783-1505
Phone (605) 755-7700

2101 Box Butte Ave
Alliance, NE 69301-4445
Phone (308) 762-4357

2116 Jackson Blvd
Rapid City, SD 57702-3495
Phone (605) 755-3900

2526 Elderberry Blvd
Rapid City, SD 57703-6589
Phone (605) 755-2273

353 Fairmont Blvd
Rapid City, SD 57701-7375

375 Berky Dr
Box Elder, SD 57719-8060
Phone (605) 755-2273

502 E Monroe St
Rapid City, SD 57701-1400
Phone (605) 755-4060

620 Four-J CT
Unit a
Gillette, WY 82716-4130
Phone (605) 755-0682

640 Flormann St
Rapid City, SD 57701-4679
Phone (605) 755-3300

Hospital & facility affiliations

  • Monument Health Rapid City Hospital Hospital, Rapid City, SD, CCN 430077
  • Monument Health Spearfish Hospital Hospital, Spearfish, SD, CCN 430048
  • Monument Health Sturgis Hospital Hospital, Sturgis, SD, CCN 431321
  • Monument Health Custer Hospital Hospital, Custer, SD, CCN 431323
  • Hans P Peterson Memorial Hospital - Cah Hospital, Philip, SD, CCN 431319

Merit-based Incentive Payment System (MIPS)

Final score
93.78 of 100Reported as apm
Quality
80.38
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair48

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Monument Health Rapid City Hospital, Inc. CurrentSince May 18, 2019 Accepting new patients
Chemung Medical Services PC Past Accepting new patients
Fort Edward Rescue Squad Inc Past Accepting new patients

Locations

353 Fairmont Blvd
Rapid City, SD 57701
Phone (605) 719-1000

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 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465776000000",
    "number": "1144238577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "571 SAINT JOSEPHS BLVD FL 2",
            "city": "ELMIRA",
            "state": "NY",
            "postal_code": "149013230",
            "telephone_number": "607-271-2050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 ROE AVE",
            "city": "ELMIRA",
            "state": "NY",
            "postal_code": "149051629",
            "telephone_number": "607-735-4623",
            "fax_number": "607-271-3711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEVINE",
        "first_name": "ETHAN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-03",
        "last_updated": "2016-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "NY",
            "license": "221196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02886946",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102254461",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elmira, NY

Sources for this page

Verify at the official NPI Registry.