David J Ettinger, MD

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

35064602 Issued in OH

Practice address

3359 Kemp Rd
Ste. 200
Beavercreek, OH 45431-2565

Phone

(937) 429-7307

Fax

(937) 429-7320

NPI assigned

Jul 14, 2005

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

Other identifiers 3

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Medical Service Associates of Xenia Inc

  • Family Medicine Physician
  • Xenia, OH
  • NPI 1982600862

  Plastic Surgery

  NPD (past)

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

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649203200000",
    "number": "1619976453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3359 KEMP RD",
            "address_2": "STE. 200",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454312565",
            "telephone_number": "937-429-7307",
            "fax_number": "937-429-7320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3359 KEMP RD",
            "address_2": "STE. 200",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454312565",
            "telephone_number": "937-429-7307",
            "fax_number": "937-429-7320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETTINGER",
        "first_name": "DAVID",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-14",
        "last_updated": "2022-04-06",
        "certification_date": "2022-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "OH",
            "license": "35064602",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0918243",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "240004305",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000011941",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dettinger3140@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "3359 Kemp Rd",
            "address_2": "Ste. 200",
            "city": "Beavercreek",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454312565",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "3359 Kemp Rd",
            "address_2": "Ste. 200",
            "city": "Beavercreek",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454312565",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Enlightened Therapy Associates, Inc.
• Archie D Enoch, MD
• Sarah Eodice
• Jordan Ernst, APRN
• Esthetic Design
• Audra Elizabeth Evans, LMT
• Carrie Lynn Evans, CNP
• Celia Carpenter Everett, PHARMD
• Jon Robert Ewig, D.D.S.
• Excel Transport

• Plastic Surgery Physician in Beavercreek, OH
• Providers in Beavercreek, OH by specialty
• Plastic Surgery Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.