Jeff D Ethridge, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

L6877 Issued in TX

Practice address

805 Kelly Creek Rd
Bulverde, TX 78163-3035

Phone

(830) 980-1805

Fax

(830) 438-5662

NPI assigned

Oct 5, 2005

Last updated

Aug 21, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family PracticeAlso: Hospice/Palliative Care, Hospitalist

Education

University of Texas Medical School at Houston, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Texas Emergency Group LLCGroup PAC ID 0345508768, 21 clinicians

Ess of Port Lavaca LLCGroup PAC ID 2769766005, 17 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorial Medical Center Hospital, Port Lavaca, TX, CCN 451356
• Cuero Regional Hospital Hospital, Cuero, TX, CCN 450597

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: fmcjethri@yourcarecommunity.org
• FHIR API: https://api.platform.athenahealth.com/18288/brand/1/csg/1/fhir/r4

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.

• Ess of Port Lavaca LLC

  • Emergency Medicine Physician
  • Port Lavaca, TX
  • NPI 1922546936
  Medicare reassignment Care Compare group NPD
• Texas Emergency Group LLC

  • Emergency Medicine Physician
  • Cuero, TX
  • NPI 1699288811
  Medicare reassignment Care Compare group
• Concord Medical Group of Texas PLLC

  • Emergency Medicine Physician
  • Lubbock, TX
  • NPI 1750790762
  Medicare reassignment NPD
• Concord Medical Group PLLC

  • Emergency Medicine Physician
  • Lubbock, TX
  • NPI 1083630610
  Medicare reassignment NPD
• Ess of Crockett, LLC

  • Emergency Medicine Physician
  • Crockett, TX
  • NPI 1649988635
  Medicare reassignment NPD
• Ess of Fairfield LLC

  • Emergency Medicine Physician
  • Fairfield, TX
  • NPI 1588132856
  Medicare reassignment NPD
• Ess of South Texas LLC

  • Emergency Medicine Physician
  • Liberty, TX
  • NPI 1295128247
  Medicare reassignment NPD
• Hni Medical Services

  • Hospitalist Physician
  • Austin, TX
  • NPI 1366735169

  Family Medicine

  Medicare reassignment NPD
• Bulverde Family Medicine PA

  • Hospitalist Physician
  • Bulverde, TX
  • NPI 1265801492
  Authorized official Same address or phone
• Citizens Medical Center County of Victoria

  • General Acute Care Hospital
  • Victoria, TX
  • NPI 1124052162
  NPD (past)
• Garza Medical Group @ South Alamo

  • Family Medicine Physician
  • San Antonio, TX
  • NPI 1396231320
  NPD (past)
• SNG - Barlite San Saba Dialysis Centers LP

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • San Antonio, TX
  • NPI 1760700298
  NPD (past)

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

• Dewitt Medical District

  dba Cuero Regional Hospital

  • Rural Acute Care Hospital
  • Cuero, TX
  • NPI 1437148020
  Care Compare affiliation
• Memorial Medical Center

  • Critical Access Hospital
  • Port Lavaca, TX
  • NPI 1689630865
  Care Compare affiliation

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

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597968000000",
    "number": "1154318095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 KELLY CREEK RD",
            "city": "BULVERDE",
            "state": "TX",
            "postal_code": "781633035",
            "telephone_number": "830-980-1805",
            "fax_number": "830-438-5662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 KELLY CREEK RD",
            "city": "BULVERDE",
            "state": "TX",
            "postal_code": "781633035",
            "telephone_number": "830-980-1805",
            "fax_number": "830-438-5662"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 Dallas St Fl 4",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782051201",
            "country_code": "US",
            "telephone_number": "830-980-1805",
            "fax_number": "830-438-5662",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3636 Medical Dr",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782292183",
            "country_code": "US",
            "telephone_number": "830-980-1805",
            "fax_number": "830-438-5662",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5757 N Knoll",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782402239",
            "country_code": "US",
            "telephone_number": "830-980-1805",
            "fax_number": "830-438-5662",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ETHRIDGE",
        "first_name": "JEFF",
        "middle_name": "D",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-05",
        "last_updated": "2020-08-21",
        "certification_date": "2020-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "L6877",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "TX",
            "license": "L6877",
            "primary": false
        },
        {
            "code": "207QH0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": "TX",
            "license": "L6877",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "167684801",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "167686808",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Bulverde, TX
• Providers in Bulverde, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.