Ethan Hoeldtke, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085.010882 Issued in IL

Practice address

17850 Kedzie Ave Ste 1150
Hazel Crest, IL 60429-2095

Phone

(877) 692-8686

NPI assigned

Jun 29, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: ethan.hoeldtke.1@13826.direct.athenahealth.com

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.

• Aunt Martha'S Health and Wellness, Inc.

  • Federally Qualified Health Center (FQHC)
  • Hazel Crest, IL
  • NPI 1174716823
  NPD (past)

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

{
    "created_epoch": "1719619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728432000000",
    "number": "1194560227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19990 GOVERNORS HWY",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17850 KEDZIE AVE STE 1150",
            "city": "HAZEL CREST",
            "state": "IL",
            "postal_code": "604292095",
            "telephone_number": "877-692-8686"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3528 E 118th St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606177314",
            "country_code": "US",
            "telephone_number": "877-692-8686",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOELDTKE",
        "first_name": "ETHAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-29",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.010882",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hickory Cardiac Care LLC
• Shirley Jean Hightower, CADC, MISA
• Nicole Judith Hill
• Tara Hill
• Lisa Hines, PHD., LCSW, LPHA
• Stacey Hogroe
• Kenneth Winston Holmes, M.D.
• Home Bound Healthcare, Inc.
• Kimberly Hough
• Lee Edward Houston, CADC

• Physician Assistant in Hazel Crest, IL
• Providers in Hazel Crest, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2024; 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.