Individual provider Active NPI

Ethan Levine

  • Medical Physician Assistant
  • Newburgh, NY
National Provider Identifier
1487182283
Registry record updated Feb 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
020831 Issued in NY
Practice address
70 Dubois St
Newburgh, NY 12550-4851
Phone
(845) 561-4400
NPI assigned
May 24, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 3863 CT
Medical Physician Assistant 363AM0700X 020831 NY Primary

Addresses

Primary practice location

70 Dubois St
Newburgh, NY 12550-4851

Mailing address

720 Pelham Rd Apt 3C
New Rochelle, NY 10805-1016

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180330000161 NY Practitioner - Physician Assistant 9335401686 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1243 Fulton St
Brooklyn, NY 11216-2004
Phone (646) 647-1257

135 Montague St
Brooklyn, NY 11201-3504
Phone (646) 346-7918

21 Graham Ave
Brooklyn, NY 11206-4007
Phone (718) 571-9280

228 - 230 Court St
Brooklyn, NY 11201-6405
Phone (718) 280-5362

336 E 86TH St
New York, NY 10028-4615
Phone (212) 772-3627

399 Knickerbocker Ave
Brooklyn, NY 11237-4101
Phone (718) 571-9168

457 Atlantic Ave
Brooklyn, NY 11217-2107
Phone (718) 530-1144

461 Fulton St
Brooklyn, NY 11201-5207
Phone (718) 571-9418

795 Manhattan Ave
Brooklyn, NY 11222-2710
Phone (718) 789-3549

Merit-based Incentive Payment System (MIPS)

Final score
86.33 of 100Reported as group
Quality
82.1
Promoting interoperability
100
Improvement activities
40
Cost
72.34

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
020831NYMDCounseling Psychologist
3863CTMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
City Medical of Upper East Side, PLLC CurrentSince Mar 29, 2022 Accepting new patients
City Medical of Upper East Side, PLLC CurrentSince Mar 29, 2022 Accepting new patients

Locations

3111 Steinway St
Astoria, NY 11103
Phone (718) 475-2345

336 E 86th St
New York, NY 10028
Phone (212) 772-3627

Interoperability endpoints

  • Direct secure messaging: ethan.levine.1@2983.direct.athenahealth.com

Organizations & group practices 4

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": "1495584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518480000000",
    "number": "1487182283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 PELHAM RD APT 3C",
            "city": "NEW ROCHELLE",
            "state": "NY",
            "postal_code": "108051016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 DUBOIS ST",
            "city": "NEWBURGH",
            "state": "NY",
            "postal_code": "125504851",
            "telephone_number": "845-561-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEVINE",
        "first_name": "ETHAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-24",
        "last_updated": "2018-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "3863",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "020831",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newburgh, NY

Sources for this page

Verify at the official NPI Registry.