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Individual provider Active NPI

Jordan Etscheidt, MD

  • Orthopaedic Surgery Physician
  • Canton, OH
National Provider Identifier
1568873446
Registry record updated Jul 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
35.139541 Issued in OH
Practice address
4466 Fulton Dr NW
Canton, OH 44718-2864
Phone
(330) 670-4006
Fax
(330) 670-4028
NPI assigned
May 14, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 35.139541 OH Primary

Addresses

Primary practice location

4466 Fulton Dr NW
Canton, OH 44718-2864

Mailing address

4466 Fulton Dr NW
Canton, OH 44718-2864
Phone (330) 670-4006

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200716002757 OH Practitioner - Orthopedic Surgery 4183940802 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Crystal Clinic, Inc.Group PAC ID 7214821586, 46 clinicians

Practice addresses (Care Compare)

4466 Fulton Dr NW
Canton, OH 44718-2864
Phone (833) 334-9007

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.83 of 100Reported as group
Quality
83.94
Promoting interoperability
100
Improvement activities
40
Cost
78.82

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement41
Knee replacement82
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Crystal Clinic, Inc. Orthopaedic Surgery CurrentSince Dec 6, 2023 Accepting new patients
Crystal Clinic Orthopaedic Center LLC Orthopaedic Surgery CurrentSince Aug 31, 2020 Accepting new patients
Crystal Clinic Inc CurrentSince Dec 6, 2023 Accepting new patients
Crystal Clinic Orthopaedic Center LLC Orthopaedic Surgery CurrentSince Aug 31, 2020 Accepting new patients
Crystal Clinic Orthopaedic Center, LLC Orthopaedic Surgery Past Accepting new patients

Locations

3975 Embassy Pkwy
Ste 202
Akron, OH 44333
Phone (330) 668-4085

3975 Embassy Pkwy
Akron, OH 44333
Phone (330) 670-4242

4466 Fulton Dr NW
Canton, OH 44718
Phone (330) 489-1386

437 Portage Trl
#1
Cuyahoga Falls, OH 44221

437 Portage Trl
Cuyahoga Fls, OH 44221
Phone (330) 929-9136

3557 Embassy Pkwy
Fairlawn, OH 44333
Phone (330) 670-1005

1622 E Turkeyfoot Lake Rd
Ste 200
Green, OH 44312
Phone (330) 644-7436

1310 Corporate Dr
Hudson, OH 44236
Phone (330) 344-3030

2007 State Route 59
Kent, OH 44240
Phone (330) 673-1904

323 High St
Ste C
Wadsworth, OH 44281
Phone (330) 335-1586

Organizations & group practices 5

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.

Hospital & facility affiliations 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1400025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595376000000",
    "number": "1568873446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4466 FULTON DR NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182864",
            "telephone_number": "330-670-4006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4466 FULTON DR NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182864",
            "telephone_number": "330-670-4006",
            "fax_number": "330-670-4028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETSCHEIDT",
        "first_name": "JORDAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-14",
        "last_updated": "2020-07-22",
        "certification_date": "2020-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "OH",
            "license": "35.139541",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, OH

Sources for this page

Verify at the official NPI Registry.