Douglas S Ettin, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

34883 Issued in KY

Practice address

4000 Kresge Way
Louisville, KY 40207-4605

Phone

(502) 899-7646

Fax

(502) 899-7648

NPI assigned

May 28, 2006

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

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Kentuckiana Emergency Physicians

  • Emergency Care Clinic/Center
  • Louisville, KY
  • NPI 1942362058
  NPD (past)
• Kentuckiana Emergency Physicians, PLLC

  • Emergency Medicine Physician
  • Louisville, KY
  • NPI 1801833140
  NPD (past)
• Louisville Radiology Imaging Consultants, PLLC

  • Diagnostic Radiology Physician
  • Owensboro, KY
  • NPI 1639115447
  NPD (past)

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1326095969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6749",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402060749",
            "telephone_number": "502-899-7646",
            "fax_number": "502-899-7648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 KRESGE WAY",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074605",
            "telephone_number": "502-899-7646",
            "fax_number": "502-899-7648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETTIN",
        "first_name": "DOUGLAS",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-28",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "KY",
            "license": "34883",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200226960",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64012388",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KENTUCKY LICENSE",
            "identifier": "34883",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Allison Anne Etling
• Steven Wayne Etoch, MD
• Danielle Etter, LCSW
• Simone S Etter, DPT
• Joseph William Etterer
• Julie C Etzel, PHD
• Jennifer Rose Eubank, OTR/L, MS
• Eubanks & Marshall PSC
• Lindsay R Eubanks, M.ED., OTR/L, ATP
• Eudaimonia PLLC

• Emergency Medicine Physician in Louisville, KY
• Providers in Louisville, KY by specialty
• Emergency Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.