NPIMap

Individual provider Active NPI

Ethan Wesley McDonald I

  • Physician Assistant
  • Wheeling, WV
National Provider Identifier
1639837784
Registry record updated Dec 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2647 Issued in WV
Practice address
10 Medical Park Ste 104
Wheeling, WV 26003-6389
Phone
(304) 242-4800
NPI assigned
Dec 6, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 6, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X 2647 WV Primary

Addresses

Primary practice location

10 Medical Park Ste 104
Wheeling, WV 26003-6389

Mailing address

206 Macallan LN Unit 1
Triadelphia, WV 26059-2464

Other practice location 1

206 Macallan Ln Unit 1
Triadelphia, WV 26059-2464
Phone (304) 671-3145

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
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
I20221104001179 WV Practitioner - Physician Assistant 4587031521 Reassigns benefits to 4 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
Wheeling Hospital IncGroup PAC ID 5799689493, 433 clinicians

Practice addresses (Care Compare)

1 Medical Ctr Dr
Morgantown, WV 26506-1200
Phone (304) 598-4865

1 Medical Park
Wheeling, WV 26003-6379

2500 Hospital Dr
Martinsburg, WV 25401-3402
Phone (304) 264-1000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.34 of 100Reported as apm
Quality
79.86
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
95.34 of 100Reported as apm
Quality
79.86
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2647WVMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wheeling Hospital Inc CurrentSince Dec 5, 2022 Accepting new patients
Jefferson Memorial Hospital CurrentSince Mar 6, 2026 Accepting new patients
University Hematology and Oncology CurrentSince Dec 5, 2022 Accepting new patients
West Virginia University Medical Corporation CurrentSince Dec 5, 2022 Accepting new patients
Jefferson Memorial Hospital CurrentSince Mar 6, 2026 Accepting new patients
Jefferson Memorial Hospital CurrentSince Mar 6, 2026 Accepting new patients
Wheeling Hospital Inc Past Accepting new patients

Locations

1 Medical Center Dr
Morgantown, WV 26506
Phone (304) 293-4500

300 S Preston St
Ranson, WV 25438
Phone (304) 728-1600

1 Medical Park
Wheeling, WV 26003
Phone (304) 243-3124

10 Medical Park
Ste 104
Wheeling, WV 26003
Phone (304) 242-4800

Interoperability endpoints

  • Direct secure messaging: emcdonald328470@direct.wvuhsdirect.com
  • FHIR API: https://apps.mywvuchart.com/fhirproxy/api/FHIR/R4/

Organizations & group practices 8

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 2

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": "1638748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670284800000",
    "number": "1639837784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 MACALLAN LN UNIT 1",
            "city": "TRIADELPHIA",
            "state": "WV",
            "postal_code": "260592464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 MEDICAL PARK STE 104",
            "city": "WHEELING",
            "state": "WV",
            "postal_code": "260036389",
            "telephone_number": "304-242-4800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "206 Macallan Ln Unit 1",
            "address_purpose": "LOCATION",
            "city": "Triadelphia",
            "state": "WV",
            "postal_code": "260592464",
            "country_code": "US",
            "telephone_number": "304-671-3145",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCDONALD",
        "first_name": "ETHAN",
        "middle_name": "WESLEY",
        "name_suffix": "I",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-12-06",
        "last_updated": "2022-12-06",
        "certification_date": "2022-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "2647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wheeling, WV

Sources for this page

Verify at the official NPI Registry.