NPIMap

Individual provider Active NPI

Ethan Fort

  • Surgical Physician Assistant
  • Hays, KS
National Provider Identifier
1588308571
Registry record updated Apr 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
Practice address
2220 Canterbury Dr
Hays, KS 67601-2370
Phone
(855) 429-7633
NPI assigned
Apr 25, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X Primary

Addresses

Primary practice location

2220 Canterbury Dr
Hays, KS 67601-2370

Mailing address

4100 Millstone Cir
Hays, KS 67601-9797
Phone (785) 259-2457

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20240819002195 MO Practitioner - Physician Assistant 8527444066 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Springfield CommunitiesGroup PAC ID 7416865845, shared by 26 NPIs, 1,121 clinicians

Practice addresses (Care Compare)

1605 Martin Springs Dr
Rolla, MO 65401-2980

2115 S Fremont Ave
3050 MC Infectious Disease Whiteside
Springfield, MO 65804-2236
Phone (417) 820-3905

3050 E River Bluff Blvd
MC Orthopedics
Ozark, MO 65721-8807
Phone (417) 820-5610

331 Hospital Dr
Lebanon, MO 65536-9251

940 W Mount Vernon St
Nixa, MO 65714-9613

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Springfield Communities CurrentSince Aug 12, 2024 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Aug 12, 2024 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Aug 12, 2024 Accepting new patients

Locations

3817 S Springfield Ave
Ste 180
Bolivar, MO 65613
Phone (417) 820-5750

448 State Highway 248
Ste 180
Branson, MO 65616
Phone (417) 820-2064

92 Main St
Cassville, MO 65625
Phone (417) 847-5225

331 Hospital Dr
Ste A
Lebanon, MO 65536
Phone (417) 532-8856

3050 E River Bluff Blvd
Ozark, MO 65721
Phone (417) 820-5610

1605 Martin Springs Dr
Ste 330
Rolla, MO 65401
Phone (573) 458-6379

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

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 and National Provider Directory roles.

Hospital & facility affiliations 11

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

NPI Registry JSON

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

{
    "created_epoch": "1650844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650844800000",
    "number": "1588308571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 MILLSTONE CIR",
            "city": "HAYS",
            "state": "KS",
            "postal_code": "676019797",
            "telephone_number": "785-259-2457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2220 CANTERBURY DR",
            "city": "HAYS",
            "state": "KS",
            "postal_code": "676012370",
            "telephone_number": "855-429-7633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORT",
        "first_name": "ETHAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-25",
        "last_updated": "2022-04-25",
        "certification_date": "2022-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hays, KS

Sources for this page

Verify at the official NPI Registry.