Ethan Short, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

54489 Issued in KY

Practice address

228 Delmont Ave
Louisville, KY 40206-1025

Phone

(502) 619-0636

NPI assigned

Apr 17, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in KY, IN2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Lifespring, Inc

  • Community/Behavioral Health Agency
  • Jeffersonville, IN
  • NPI 1851489942
  Medicare reassignment NPD
• WSH Holdings in LLC

  • Psychiatry Physician
  • Indianapolis, IN
  • NPI 1487516860

  KY

  Medicare reassignment
• Lifespring, Inc

  • Community/Behavioral Health Agency
  • Dale, IN
  • NPI 1639029283
  NPD

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

{
    "created_epoch": "1492387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692662400000",
    "number": "1629502604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "228 DELMONT AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402061025",
            "telephone_number": "502-619-0636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "228 DELMONT AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402061025",
            "telephone_number": "502-619-0636"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5722 Outer Loop",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402194156",
            "country_code": "US",
            "telephone_number": "502-492-7455",
            "fax_number": "502-921-0222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHORT",
        "first_name": "ETHAN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-04-17",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": "01091358A",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "KY",
            "license": "R4865",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "KY",
            "license": "54489",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "KY",
            "license": "54489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Harold Edwin Shoop III, PHARMD
• Samuel Chase Shoptaw I, APRN, FNP-C
• Allison Hafele Short, DPT
• Brenda Short
• Elizabeth Short
• Kerry Lynn Short, M.D.
• Margaret Elizabeth Short, OTR/L
• Olivia Short
• Rebecca Hope Short, LCSW
• David L Shorten, D.M.D.

• Psychiatry Physician in Louisville, KY
• Providers in Louisville, KY by specialty
• Psychiatry Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2023; 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.