Active NPI
Ethan Bardell
- Counselor
- Cortland, NY
National Provider Identifier
1215583067
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 101837
- Practice address
- 165 Main St
Ste a
Cortland, NY 13045-3049 - Phone
- (607) 753-0234
- NPI assigned
- Aug 16, 2019
- Last updated
- Aug 16, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 101837 | NY | Primary |
Addresses
Primary practice location
165 Main St
Ste a
Cortland, NY 13045-3049
Mailing address
165 Main St
Ste a
Cortland, NY 13045-3049
Phone (607) 753-0234
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
109 W 27TH St
5S
New York, NY 10001-6208
Phone (833) 351-8255
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 101837 | NY | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MCCD Psychiatry Services PLLC | Current | Accepting new patients |
Locations
109 W 27th St
#55
New York, NY 10001
109 W 27th St
Rm 5S
New York, NY 10001
Phone (332) 230-4572
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1565913600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565913600000",
"number": "1215583067",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "165 MAIN ST",
"address_2": "STE A",
"city": "CORTLAND",
"state": "NY",
"postal_code": "130453049",
"telephone_number": "607-753-0234"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "165 MAIN ST",
"address_2": "STE A",
"city": "CORTLAND",
"state": "NY",
"postal_code": "130453049",
"telephone_number": "607-753-0234"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BARDELL",
"first_name": "ETHAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-08-16",
"last_updated": "2019-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "NY",
"license": "101837",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cortland, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2019; 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.