Gino Shwkat Etta, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

35.141973 Issued in OH

Practice address

27351 Dequindre Rd
Madison Heights, MI 48071-3487

Phone

(248) 967-7661

Fax

(248) 967-7876

NPI assigned

May 24, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OH, MI2 enrollments

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 2

Specialty

Emergency Medicine

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Independent Emergency Physicians PCGroup PAC ID 6709798325, 173 clinicians

Independent Observation Physicians PLLCGroup PAC ID 3577603604, 138 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Henry Ford Health Warren Hospital Hospital, Warren, MI, CCN 230195
• Magruder Hospital Hospital, Port Clinton, OH, CCN 361314
• Straith Hospital for Special Surgery Hospital, Southfield, MI, CCN 230071

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Independent Emergency Physicians, P.C.

  • Emergency Medical Services (Emergency Medicine) Physician
  • Southfield, MI
  • NPI 1780791343

  OH

  Medicare reassignment Care Compare group NPD
• Independent Observation Physicians PLLC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Southfield, MI
  • NPI 1700119500
  Medicare reassignment Care Compare group NPD
• Emergency Department Physicians, P.C.

  • Emergency Medicine Physician
  • Detroit, MI
  • NPI 1225083595
  Medicare reassignment NPD
• JTDM Family Practice LLC

  • Family Medicine Physician
  • Saint Marys, OH
  • NPI 1184652539
  NPD (past)
• Lima Memorial Joint Operating Company

  dba Lima Memorial Health System

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

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

• Henry Ford Health Macomb Oakland Hospital

  dba St. John Macomb Oakland Hospital-Warren Campus

  • General Acute Care Hospital
  • Warren, MI
  • NPI 1124099858
  Care Compare affiliation
• Henry Ford Health Macomb Oakland Hospital

  dba St John Macomb Oakland - Oakland Center

  • General Acute Care Hospital
  • Madison Heights, MI
  • NPI 1215139233
  Care Compare affiliation
• Straith Hospital for Special Surgery

  • General Acute Care Hospital
  • Southfield, MI
  • NPI 1548268436
  Care Compare affiliation
• H.B. Magruder Memorial Hospital

  dba Magruder Hospital

  • Critical Access Hospital
  • Port Clinton, OH
  • NPI 1922079532
  Care Compare affiliation

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

{
    "created_epoch": "1527120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635984000000",
    "number": "1194216101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27351 DEQUINDRE RD",
            "city": "MADISON HEIGHTS",
            "state": "MI",
            "postal_code": "480713487",
            "telephone_number": "248-967-7661",
            "fax_number": "248-967-7876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27351 DEQUINDRE RD",
            "city": "MADISON HEIGHTS",
            "state": "MI",
            "postal_code": "480713487",
            "telephone_number": "248-967-7661",
            "fax_number": "248-967-7876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETTA",
        "first_name": "GINO",
        "middle_name": "SHWKAT",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-05-24",
        "last_updated": "2021-11-04",
        "certification_date": "2021-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "4301501047",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "35.141973",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• ENT Surgical Assoc PC
• Daniel Wallace Enyia
• Eric S Smith DDS PC
• Erica Ann Errigo, DO
• Ranna Esho, PHARMD
• Evolve Pharmacy LLC
• Rita Ezeh
• Family Care Dentistry
• Family Care Medical Clinic PLLC
• Oluwafemi Fashina

• Emergency Medicine Physician in Madison Heights, MI
• Providers in Madison Heights, MI by specialty
• Emergency Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2021; 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.