Individual provider Active NPI

Jason Gibbs Ethington, M.D.

  • Ophthalmology Physician
  • Niles, IL
National Provider Identifier
1295962074
Registry record updated Apr 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
125.056717 Issued in IL
Practice address
7421 N Milwaukee Ave
Niles, IL 60714-3707
Phone
(773) 775-0811
Fax
(773) 819-7013
NPI assigned
Jun 18, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 125.056717 IL Primary

Addresses

Primary practice location

7421 N Milwaukee Ave
Niles, IL 60714-3707

Mailing address

7421 N Milwaukee Ave
Niles, IL 60714-3707
Phone (773) 993-0279

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20131018001009 IL Practitioner - Ophthalmology 5092949479 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Loyola University of Chicago, Stritch School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Milwaukee Avenue Eye Center, S.C.Group PAC ID 1456489228, 9 clinicians

Practice addresses (Care Compare)

7421 N Milwaukee Ave
Niles, IL 60714-3707
Phone (773) 775-0811

Merit-based Incentive Payment System (MIPS)

Final score
89.01 of 100Reported as group
Quality
89.19
Improvement activities
40
Cost
77.77

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery259
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125.056717ILMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ma Optical, PLLC CurrentSince May 1, 2022 Accepting new patients
Niles Surgery Center LLC Past Accepting new patients

Locations

7421 N Milwaukee Ave
Niles, IL 60714
Phone (773) 631-2980

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1245283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682294400000",
    "number": "1295962074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7421 N MILWAUKEE AVE",
            "city": "NILES",
            "state": "IL",
            "postal_code": "607143707",
            "telephone_number": "773-993-0279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7421 N MILWAUKEE AVE",
            "city": "NILES",
            "state": "IL",
            "postal_code": "607143707",
            "telephone_number": "773-775-0811",
            "fax_number": "773-819-7013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETHINGTON",
        "first_name": "JASON",
        "middle_name": "GIBBS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-18",
        "last_updated": "2023-04-24",
        "certification_date": "2023-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IL",
            "license": "125.056717",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Niles, IL

Sources for this page

Verify at the official NPI Registry.