Theodore Webster Etling Jr., PSYD

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

4204 Issued in AZ

Practice address

7400 S Power Rd Ste 120
Gilbert, AZ 85297-9283

Phone

(480) 926-0644

Fax

(480) 926-0645

NPI assigned

Sep 24, 2010

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 1

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gilbert Neurology Partners PLLCGroup PAC ID 4587852793, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Gilbert Neurology Partners PLLC

  • Neurology Physician
  • Gilbert, AZ
  • NPI 1417266305
  Medicare reassignment Care Compare group NPD
• Neurosin PLLC

  • Physical Medicine & Rehabilitation Physician
  • Chandler, AZ
  • NPI 1396378816
  NPD
• Naveed Vehra MD PLLC

  • Neurology Physician
  • Glendale, AZ
  • NPI 1891930061
  NPD (past)

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

{
    "created_epoch": "1285286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697500800000",
    "number": "1497063424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7400 S POWER RD STE 120",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852979283",
            "telephone_number": "480-926-0644",
            "fax_number": "480-926-0645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7400 S POWER RD STE 120",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852979283",
            "telephone_number": "480-926-0644",
            "fax_number": "480-926-0645"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11225 N 28th Dr Ste B215",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850295649",
            "country_code": "US",
            "telephone_number": "602-686-8161",
            "fax_number": "480-630-7748",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ETLING",
        "first_name": "THEODORE",
        "middle_name": "WEBSTER",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-24",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "AZ",
            "license": "4204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "644018",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Amir Michael Etebari, DDS
• Amir Etemad, MD
• Carla Jean Ethridge, R.N.
• Eureka Annex Residence
• Eureka Imperial Residence
• Eureka Imperial Residence
• Eureka Imperial Residence 3
• Ev Chiropractic, LLC

• Clinical Neuropsychologist in Gilbert, AZ
• Providers in Gilbert, AZ by specialty
• Clinical Neuropsychologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 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.
• 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.