Ethan Leroy Snyder, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA63622 Issued in CA

Practice address

585 N Mountain Ave Ste a
Upland, CA 91786-8516

Phone

(909) 608-7546

NPI assigned

Jun 6, 2022

Last updated

Jan 6, 2024By 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

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Physician Assistant

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pacific Dermatology InstituteGroup PAC ID 2062546260, 32 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pacific Dermatology Institute

  • Dermatology Physician
  • Corona, CA
  • NPI 1740410182
  Medicare reassignment Care Compare group
• Advanced Dermatology & Cosmetics Laser Care a Medical Corporation

  • Specialist
  • Valencia, CA
  • NPI 1912026097
  NPD (past)

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

{
    "created_epoch": "1654473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704499200000",
    "number": "1508595729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E REDLANDS BLVD STE 284",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923734721",
            "telephone_number": "909-312-7380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "585 N MOUNTAIN AVE STE A",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917868516",
            "telephone_number": "909-608-7546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SNYDER",
        "first_name": "ETHAN",
        "middle_name": "LEROY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-06",
        "last_updated": "2024-01-06",
        "certification_date": "2024-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA63622",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Gregory Smith, MD
• Scott Keith Smith, CMT
• Stacy Lynn Smith, CADC-II
• Willie Smith, 14558-RAC
• Joshua James Snook
• Jimmy K. So, OD
• Soar & Live Inc
• Soheil Lahijani M.D., a Medical Corporation (California Family Planning)
• Solana Dental Corporation
• Munesh Solanki

• Physician Assistant in Upland, CA
• Providers in Upland, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2024; 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.