Ethan Shakeel Jefferson, PA-C

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

67370 Issued in CA

Practice address

280 Sierra College Dr Ste 207
Grass Valley, CA 95945-5769

Phone

(530) 477-7390

Fax

(530) 477-7389

NPI assigned

Nov 19, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

University of California, Davis School of Medicine, 2025

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Hospital & facility affiliations

• Oroville Hospital Hospital, Oroville, CA, CCN 050030
• Sierra Nevada Memorial Hospital Hospital, Grass Valley, CA, CCN 050150

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/HGJJAD

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.

• Bouchier-Pritchett Family Medicine PC

  • Family Medicine Physician
  • Grass Valley, CA
  • NPI 1942737176
  Medicare reassignment NPD

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

• Oroville Hospital

  • General Acute Care Hospital
  • Oroville, CA
  • NPI 1871606269
  Care Compare affiliation
• Sierra Nevada Memorial-Miners Hospital

  dba Sierra Nevada Memorial Hospital

  • General Acute Care Hospital
  • Grass Valley, CA
  • NPI 1659361392
  Care Compare affiliation

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

{
    "created_epoch": "1731974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764720000000",
    "number": "1275358806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2725 I ST APT 2",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958164367",
            "telephone_number": "530-615-1615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 SIERRA COLLEGE DR STE 207",
            "city": "GRASS VALLEY",
            "state": "CA",
            "postal_code": "959455769",
            "telephone_number": "530-477-7390",
            "fax_number": "530-477-7389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEFFERSON",
        "first_name": "ETHAN",
        "middle_name": "SHAKEEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-11-19",
        "last_updated": "2025-12-03",
        "certification_date": "2025-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "67370",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul A. Jaffe, L.C.S.W.
• James C. Wallace DDS (Grass Valley Dentistry)
• Jacqueline James
• Janam Gill DDS
• Carl Frederick Jefferson, C.A.S.
• Lavurne Jeffreys
• Jennifer Hoffman, LMFT
• Amanda Jensen
• Eric Jensen
• Faye Whiting Jensen, M.D.

• Family Medicine Physician in Grass Valley, CA
• Providers in Grass Valley, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2025; 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.