NPIMap

Individual provider Active NPI

Ethan M Delekta, PA-C

  • Physician Assistant
  • Neenah, WI
National Provider Identifier
1407662257
Registry record updated Jul 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
8509-23 Issued in WI
Practice address
333 N Commercial St Ste 100
Neenah, WI 54956-2675
Phone
(920) 722-1750
NPI assigned
Dec 6, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 8509-23 WI Primary

Addresses

Primary practice location

333 N Commercial St Ste 100
Neenah, WI 54956-2675

Mailing address

PO Box 814
New Cumberland, WV 26047-0814
Phone (304) 374-5039

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250908003926 WI Practitioner - Physician Assistant 7618479684 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radiology Associates of the Fox Valley SCGroup PAC ID 0446152748, 73 clinicians

Practice addresses (Care Compare)

100 County Rd B
Shawano, WI 54166-7072
Phone (614) 340-7740

130 2ND St
Neenah, WI 54956-2883
Phone (920) 729-3100

1506 S Oneida St
Appleton, WI 54915-1305
Phone (920) 738-2000

225 Memorial Dr
Berlin, WI 54923-1243
Phone (614) 340-7740

800 Riverside Dr
Waupaca, WI 54981-1943
Phone (715) 258-1000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8509-23WIMDPhysician Assistant

Organizations & group practices 1

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.

Hospital & facility affiliations 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1733443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753401600000",
    "number": "1407662257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 814",
            "city": "NEW CUMBERLAND",
            "state": "WV",
            "postal_code": "260470814",
            "telephone_number": "304-374-5039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 N COMMERCIAL ST STE 100",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549562675",
            "telephone_number": "920-722-1750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELEKTA",
        "first_name": "ETHAN",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-12-06",
        "last_updated": "2025-07-25",
        "certification_date": "2025-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "8509-23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Neenah, WI

Sources for this page

Verify at the official NPI Registry.