Ethan Joseph Garofalo, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

302 Tyson Ave Ste B
Paris, TN 38242-4555

Phone

(941) 893-9148

NPI assigned

Jun 26, 2024

Sex

Male

Sole proprietor

Yes

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 TX

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Rolling Hills Clinic

  • Federally Qualified Health Center (FQHC)
  • Red Bluff, CA
  • NPI 1679988950

  TX

  Medicare reassignment NPD (past)

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

{
    "created_epoch": "1719360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719360000000",
    "number": "1598500027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 TYSON AVE STE B",
            "city": "PARIS",
            "state": "TN",
            "postal_code": "382424555",
            "telephone_number": "941-893-9148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 TYSON AVE STE B",
            "city": "PARIS",
            "state": "TN",
            "postal_code": "382424555",
            "telephone_number": "941-893-9148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAROFALO",
        "first_name": "ETHAN",
        "middle_name": "JOSEPH",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-06-26",
        "last_updated": "2024-06-26",
        "certification_date": "2024-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaitlyn Wood Fussell, RN
• G Dan Kimberlin, M.D., P.a.
• Chad M Galle, CRNA
• Ganm, LLC
• Patricia Gardner
• Lauren Neale Gentry, RN
• Loic Maxime Gerville-Reache, PT
• Alycia D Gibson, PAC
• Wayne St. M Gibson, M.D.
• Robert David Gillespie, MA

• Physician Assistant in Paris, TN
• Providers in Paris, TN by specialty
• Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.