Ethan E Dubravsky, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA11118 Issued in TX

Practice address

2130 NE Loop 410 Ste 100
San Antonio, TX 78217-4660

Phone

(210) 656-7177

Fax

(210) 656-3687

NPI assigned

Mar 29, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

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

Merit-based Incentive Payment System (MIPS)

Final score

85.12 of 100Reported as apm

Quality

67.48

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ethan.dubravsky@txo.ikm.direct-ci.com
• Direct secure messaging: ethan.dubravsky1@txo.ikm.direct-ci.com

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.

• Texas Oncology PA

  • Medical Oncology Physician
  • El Paso, TX
  • NPI 1811944101
  Medicare reassignment
• Travis County Emergency Physicians PA

  • Emergency Medicine Physician
  • Austin, TX
  • NPI 1962440933
  Medicare reassignment
• Texas Oncology PA

  • Medical Oncology Physician
  • Dallas, TX
  • NPI 1003083445
  NPD

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

{
    "created_epoch": "1490745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657843200000",
    "number": "1487186508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 911230",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753911230",
            "telephone_number": "972-997-8000",
            "fax_number": "972-234-0813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2130 NE LOOP 410 STE 100",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782174660",
            "telephone_number": "210-656-7177",
            "fax_number": "210-656-3687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUBRAVSKY",
        "first_name": "ETHAN",
        "middle_name": "E",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-03-29",
        "last_updated": "2022-07-15",
        "certification_date": "2022-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA11118",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA11118",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "375669402",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Holly Colleen Dubois, M.D.
• Jeffery Coleman Dubois, M.D.
• Jessica A Dubon
• Antionetta Shayree Dubose
• Charles David Dubose, MD
• Emily Grace Dubuisson, MD
• Jason Dubyoski, MS; CSCS
• Anna Gabrielle Duce, BCABA
• Mary Louise Ducharme, OTR
• Colette Lynn Duciaume-Wright, LCSW

• Medical Physician Assistant in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Medical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.