Ethan Birdwell

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

1202 Monroe Dr
Shawnee, OK 74804-4139

Phone

(405) 517-3806

NPI assigned

Oct 14, 2022

Last updated

Oct 14, 2022By the provider in NPPES

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1665705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665705600000",
    "number": "1457077190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 MONROE DR",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748044139",
            "telephone_number": "405-517-3806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 MONROE DR",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748044139",
            "telephone_number": "405-517-3806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BIRDWELL",
        "first_name": "ETHAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-10-14",
        "last_updated": "2022-10-14",
        "certification_date": "2022-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "OK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "okkthc.com",
            "affiliation": "N",
            "address_1": "1202 Monroe Dr",
            "city": "Shawnee",
            "state": "OK",
            "country_code": "US",
            "postal_code": "748044139",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jordan Benson
• Annette Bentley
• Bethel Public Schools
• Caitlin Dawn Bilyeu
• Bio-Medical Applications of Oklahoma, Inc. (Bma Shawnee)
• Bison Family Therapy Institute, PLLC
• Jamil H Bitar, M.D.
• Ian Robert Bittle, DPH
• Wade Bittle, P.A.-C
• Richard Blackburn, LADC

• Case Manager/Care Coordinator in Shawnee, OK
• Providers in Shawnee, OK by specialty
• Case Manager/Care Coordinator in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.