Ethan Tanner O'Connell, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

106348 Issued in MN

Practice address

1233 34TH St NW
Bemidji, MN 56601-5112

Phone

(218) 333-5596

NPI assigned

Oct 1, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in WY

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Memorial Hospital of Converse County

  • General Practice Physician
  • Douglas, WY
  • NPI 1356496491
  Medicare reassignment NPD
• Washakie Medical Center

  • Critical Access Hospital
  • Worland, WY
  • NPI 1255368593
  NPD
• Brazos Valley ER, LLC

  • Emergency Care Clinic/Center
  • Bryan, TX
  • NPI 1710417761
  NPD (past)
• USA Emergency Centers - Clear Lake, LLC

  • Emergency Care Clinic/Center
  • Houston, TX
  • NPI 1891210639
  NPD (past)

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

{
    "created_epoch": "1222819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348704000000",
    "number": "1306097928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1233 34TH ST NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566015112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1233 34TH ST NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566015112",
            "telephone_number": "218-333-5596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'CONNELL",
        "first_name": "ETHAN",
        "middle_name": "TANNER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-01",
        "last_updated": "2012-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WY",
            "license": "TL1362",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301092736",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MN",
            "license": "106348",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Northwoods Counseling Services LTD
• Northwoods Interfaith Volunteer Caregivers Program
• Megan Lynn Norton, LICSW
• Ann Steidler Nygard, LPCC
• Johnna Nynas, M.D.
• Samantha O'Hern, LSW/LADC
• Chukwuma S Ogugua, MD
• Gregory Lawton Oja, M.S.
• Ryan E Okerlund, PHARMD
• Sylvia Olney, LMFT

• Emergency Medicine Physician in Bemidji, MN
• Providers in Bemidji, MN by specialty
• Emergency Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.