Individual provider Active NPI

Ethan Walter Scott, M.D.

  • Anesthesiology Physician
  • Farmington, NM
National Provider Identifier
1225251820
Registry record updated Dec 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
M-9833 Issued in ID
Practice address
801 W Maple St
Farmington, NM 87401-5630
Phone
(505) 609-2000
NPI assigned
Apr 11, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X M-9833 ID Primary

Addresses

Primary practice location

801 W Maple St
Farmington, NM 87401-5630

Mailing address

5775 Paseo del Rancho
Farmington, NM 87402-3082
Phone (210) 834-5508

Other practice location 1

3851 Roger Brooke Dr
San Antonio, TX 78234-4501
Phone (210) 916-8499

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, NM2 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

Enrollment IDStateProvider typePAC IDDetails
I20120523000173 WA Practitioner - Anesthesiology 1951564376 Reassigns benefits to 1 organization
I20190820004199 NM Practitioner - Anesthesiology 1951564376 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Alabama School of Dentistry, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

801 W Maple St
Sjrmc ER Physicians
Farmington, NM 87401-5630
Phone (505) 609-2000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.97 of 100Reported as group
Quality
79.73
Promoting interoperability
100
Improvement activities
40
Cost
78.87

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M-9833IDMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Anesthesia of Richland a Division of Premier Anesthesia, LLC Anesthesiology CurrentSince May 21, 2012 Accepting new patients
San Juan Regional Medical Center Inc Anesthesiology CurrentSince Jul 1, 2019 Accepting new patients
San Juan Regional Medical Center Inc Current Accepting new patients
San Juan Regional Medical Center Inc CurrentSince Jul 1, 2019 Accepting new patients

Locations

801 W Maple St
Farmington, NM 87401
Phone (505) 325-5011

520 N 4th Ave
Pasco, WA 99301
Phone (509) 544-6140

888 Swift Blvd
Richland, WA 99352
Phone (509) 942-2115

Organizations & group practices 4

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733961600000",
    "number": "1225251820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5775 PASEO DEL RANCHO",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874023082",
            "telephone_number": "210-834-5508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 W MAPLE ST",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874015630",
            "telephone_number": "505-609-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3851 Roger Brooke Dr",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782344501",
            "country_code": "US",
            "telephone_number": "210-916-8499",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SCOTT",
        "first_name": "ETHAN",
        "middle_name": "WALTER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-11",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "ID",
            "license": "M-9833",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, NM

Sources for this page

Verify at the official NPI Registry.