Ethan Nere Beaudett, D.O

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

290946 Issued in NY

Practice address

738 Library Road
#1
Rochester, NY 14627-0617

Phone

(585) 275-2662

Fax

(585) 276-0149

NPI assigned

Jun 11, 2014

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

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in NY

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: Osteopathic Manipulative Medicine, Sports Medicine

Education

University of New England, College of Osteo Medicine, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University of RochesterGroup PAC ID 5799699088, 960 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• University of Rochester

  • Internal Medicine Physician
  • Rochester, NY
  • NPI 1710226824
  Medicare reassignment Care Compare group NPD
• University of Rochester

  dba University Health Service

  • Primary Care Clinic/Center
  • Rochester, NY
  • NPI 1548583305
  NPD
• University of Rochester

  dba Strong Memorial Hospital-University of Rochester

  • Community/Retail Pharmacy
  • Rochester, NY
  • NPI 1598476269
  NPD

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

{
    "created_epoch": "1402444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688083200000",
    "number": "1205240835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "738 LIBRARY ROAD",
            "address_2": "PO BOX 270617",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146270617",
            "telephone_number": "585-275-2662",
            "fax_number": "585-276-0149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "738 LIBRARY ROAD",
            "address_2": "#1",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146270617",
            "telephone_number": "585-275-2662",
            "fax_number": "585-276-0149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEAUDETT",
        "first_name": "ETHAN",
        "middle_name": "NERE",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-11",
        "last_updated": "2023-06-30",
        "certification_date": "2020-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "290946",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "NY",
            "license": "290946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ebeaudett116771@direct.urmc.rochester.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "OTHER",
            "address_1": "601 Elmwood Ave",
            "city": "Rochester",
            "state": "NY",
            "country_code": "US",
            "postal_code": "146420001",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ebeaudett116771@direct.urmc.rochester.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "OTHER",
            "address_1": "601 Elmwood Ave",
            "city": "Rochester",
            "state": "NY",
            "country_code": "US",
            "postal_code": "146420001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kayla B Beatty
• Linda D. Beaty
• Sierra Beaty, PA-C
• Olennda Beaubriant, NP
• Mary A Beauchamp, PHARMD
• Amy Lynn Beaulieu, SLP
• Debbie Jane Beauregard, PT
• Beautiful Birth Choices, LLC
• Tieg Erin Beazer, DO
• Philip John Bechard, D.C.

• Sports Medicine (Family Medicine) Physician in Rochester, NY
• Providers in Rochester, NY by specialty
• Sports Medicine (Family Medicine) Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2023; 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.