Active NPI
Ethan R Levine, PH.D.
- Adult Development & Aging Psychologist
- Concord, NC
National Provider Identifier
1538300025
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Development & Aging Psychologist
- Practice address
- 101 Cabarrus Ave E
Concord, NC 28025-3699 - Phone
- (888) 849-7379
- Fax
- (855) 857-7333
- NPI assigned
- Mar 13, 2009
- Last updated
- Apr 8, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 7
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | |||
| Adult Development & Aging Psychologist | 103TA0700X | Primary | ||
| Clinical Psychologist | 103TC0700X | 650 | NC | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | |||
| Exercise & Sports Psychologist | 103TE1100X | |||
| Health Service Psychologist | 103TH0100X | |||
| Rehabilitation Psychologist | 103TR0400X |
Addresses
Primary practice location
101 Cabarrus Ave E
Concord, NC 28025-3699
Mailing address
101 Cabarrus Ave E
Concord, NC 28025-3699
Phone (888) 849-7379
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P01164443 | Other | NC | RR MEDICARE |
| 14040 | Other | NC | BCBS |
| 6001139 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1977
- Medicare assignment
- May accept Medicare assignment
- Group practices
Practice addresses (Care Compare)
101 Cabarrus Ave E
Suite 200
Concord, NC 28025-3781
Phone (855) 743-2247
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0650 | NC | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eventus Wholehealth, PLLC | Psychologist | Current | Accepting new patients |
| Ethan R. Levine, PH.D. | Clinical | Current | Accepting new patients |
| Jones Outreach Services, LLP | Past | Accepting new patients |
Interoperability endpoints
- https://fhir.meditouchehr.com/api/fhir/r4/
Organizations & group practices 3
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.
-
- Clinical Psychologist
- Raleigh, NC
- NPI 1972002004
-
- Mental Health Counselor
- Zebulon, NC
- NPI 1982902052
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1236902400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1586304000000",
"number": "1538300025",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 CABARRUS AVE E",
"city": "CONCORD",
"state": "NC",
"postal_code": "280253699",
"telephone_number": "888-849-7379",
"fax_number": "855-857-7333"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 CABARRUS AVE E",
"city": "CONCORD",
"state": "NC",
"postal_code": "280253699",
"telephone_number": "888-849-7379",
"fax_number": "855-857-7333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEVINE",
"first_name": "ETHAN",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-03-13",
"last_updated": "2020-04-08",
"certification_date": "2020-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TA0700X",
"taxonomy_group": "",
"desc": "Psychologist, Adult Development & Aging",
"state": null,
"license": null,
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "650",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TE1100X",
"taxonomy_group": "",
"desc": "Psychologist, Exercise & Sports",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TH0100X",
"taxonomy_group": "",
"desc": "Psychologist, Health Service",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TR0400X",
"taxonomy_group": "",
"desc": "Psychologist, Rehabilitation",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P01164443",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "14040",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6001139",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Concord, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2020; 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.