Active NPI
Ethan Taylor
- Certified Registered Nurse Anesthetist
- Tyler, TX
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- AP132890
- Practice address
- 800 E Dawson St
Tyler, TX 75701-2036 - Phone
- (903) 606-4522
- NPI assigned
- Dec 27, 2016
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 853309 | TX | |
| Registered Nurse | 163W00000X | RN139391 | LA | |
| Certified Registered Nurse Anesthetist | 367500000X | AP132890 | TX | Primary |
Addresses
Primary practice location
800 E Dawson St
Tyler, TX 75701-2036
Mailing address
PO Box 841656
Dallas, TX 75284-1656
Phone (903) 531-5000
Other practice location 1
800 E Dawson St
Tyler, TX 75701-2036
Phone (903) 606-4522
Other practice location 2
2901 4th St
Longview, TX 75605-5128
Phone (903) 758-1818
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 367663705 | Medicaid | TX | |
| 8LX980 | Other | TX | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1000 S Beckham Ave
Tyler, TX 75701-1908
Phone (903) 531-8890
2901 4TH St
Longview, TX 75605-5128
Phone (903) 232-3606
3315 S Alameda St
Corpus Christi, TX 78411-1820
Phone (214) 687-0001
7400 Barlite Blvd
San Antonio, TX 78224-1308
Phone (210) 921-2000
Hospital & facility affiliations
- Ut Health East Texas Tyler Regional Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN139391 | LA | MD | Registered Nurse |
| 853309 | TX | MD | Registered Nurse |
| AP132890 | TX | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Longview Medical Center LP | Current | Accepting new patients | |
| Christus Good Shepherd Medical Center | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
| Longview Medical Center LP | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
| Mother Frances Hospital Regional Health Care Center | Current | Accepting new patients | |
| Emergenchealth PLLC | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
| Christus Good Shepherd Medical Center | Current | Accepting new patients | |
| Northstar Anesthesia III PA | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
Locations
14425 Falcon Head Blvd
#11
Austin, TX 78738
Phone (512) 900-1006
3080 College St
#T
Beaumont, TX 77701
Phone (409) 212-5002
3315 S Alameda St
Corpus Christi, TX 78411
Phone (361) 761-1400
6949 Bryant Irvin Rd
Ste 110
Ft Worth, TX 76132
Phone (817) 332-1818
6800 N MacArthur Blvd
Irving, TX 75039
Phone (972) 969-2000
700 E Marshall Ave
Longview, TX 75601
Phone (903) 236-2000
2901 4th St
Longview, TX 75605
Phone (281) 371-1800
811 S Washington Ave
Marshall, TX 75670
Phone (903) 315-1488
4920 NE Stallings Dr
Nacogdoches, TX 75965
Phone (936) 568-3441
4600 E Sam Houston Pkwy S
Pasadena, TX 77505
Phone (713) 853-9302
7400 Barlite Blvd
San Antonio, TX 78224
Phone (210) 921-2000
800 E Dawson St
Tyler, TX 75701
Phone (903) 531-5018
1000 S Beckham Ave
Tyler, TX 75701
Phone (903) 526-1068
11937 US Highway 271
Tyler, TX 75708
Phone (903) 877-3451
Organizations & group practices 7
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.
-
- Anesthesiology Physician
- Fort Worth, TX
- NPI 1467970897
Nurse Anesthetist, Certified Registered
-
- Anesthesiology Physician
- Corpus Christi, TX
- NPI 1356968952
Nurse Anesthetist, Certified Registered
-
- Anesthesiology Physician
- Marshall, TX
- NPI 1760908404
Nurse Anesthetist, Certified Registered
-
- Certified Registered Nurse Anesthetist
- Longview, TX
- NPI 1508824038
Nurse Anesthetist, Certified Registered
-
- General Acute Care Hospital
- Tyler, TX
- NPI 1679578439
-
- General Acute Care Hospital
- Longview, TX
- NPI 1124092036
-
- Rehabilitation Hospital Unit
- Longview, TX
- NPI 1699733097
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Tyler, TX
- NPI 1407364847
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1482796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1619740800000",
"number": "1255876348",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 841656",
"city": "DALLAS",
"state": "TX",
"postal_code": "752841656",
"telephone_number": "903-531-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 E DAWSON ST",
"city": "TYLER",
"state": "TX",
"postal_code": "757012036",
"telephone_number": "903-606-4522"
}
],
"practiceLocations": [
{
"address_1": "800 E Dawson St",
"address_purpose": "LOCATION",
"city": "Tyler",
"state": "TX",
"postal_code": "757012036",
"country_code": "US",
"telephone_number": "903-606-4522",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2901 4th St",
"address_purpose": "LOCATION",
"city": "Longview",
"state": "TX",
"postal_code": "756055128",
"country_code": "US",
"telephone_number": "903-758-1818",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "TAYLOR",
"first_name": "ETHAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-12-27",
"last_updated": "2021-04-30",
"certification_date": "2021-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "TX",
"license": "853309",
"primary": false
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "LA",
"license": "RN139391",
"primary": false
},
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "TX",
"license": "AP132890",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "367663705",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "8LX980",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.