Ethan Weckstein, D.O.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

036.154155 Issued in IL

Practice address

934 S Garfield Ave Ste a
Traverse City, MI 49686-2402

Phone

(231) 935-0355

NPI assigned

Mar 28, 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 IL

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

Psychiatry

Education

Midwestern University, Chicago College of Osteopathic Med, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

2014 Health LLCGroup PAC ID 2365764024, 22 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ethan.weckstein.1@23955.direct.athenahealth.com
• Direct secure messaging: ethan.weckstein.1@13676.direct.athenahealth.com
• Direct secure messaging: eweckstein93423@direct.luhs.org

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.

• 2014 Health, LLC

  • Psychiatric Hospital
  • Des Plaines, IL
  • NPI 1083021877
  Medicare reassignment Care Compare group NPD
• Innovative IV Care, PLLC

  • Emergency Medicine Physician
  • Chicago, IL
  • NPI 1457818098
  Medicare reassignment NPD
• Loyola University Medical Center

  • General Acute Care Hospital
  • Maywood, IL
  • NPI 1376521575
  NPD

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

{
    "created_epoch": "1522195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658966400000",
    "number": "1235634403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "934 S GARFIELD AVE STE A",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496862402",
            "telephone_number": "231-935-0355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "934 S GARFIELD AVE STE A",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496862402",
            "telephone_number": "231-935-0355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WECKSTEIN",
        "first_name": "ETHAN",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-03-28",
        "last_updated": "2022-07-28",
        "certification_date": "2022-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "5101025942",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036.154155",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin P Weber, M.D.
• Sydney R Weber
• Barbara J Webster, CAC
• Daniel M Webster, MD
• Emma Webster
• Sander M Weckstein, M.D.
• Taylor Weckstein, MD
• Wendy Weckstein, PT
• Rebekah Rose Cleo Weeks, DO
• Sara Ellen Wehner

• Psychiatry Physician in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Psychiatry Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2022; 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.