NPIMap

Individual provider Active NPI

Ethan Matthew Fan

  • Internal Medicine Physician
  • Dallas, TX
National Provider Identifier
1649913138
Registry record updated Dec 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
W0570 Issued in TX
Practice address
8200 Walnut Hill LN
Dallas, TX 75231-4402
Phone
(214) 345-6176
Fax
(214) 345-5167
NPI assigned
Apr 14, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X W0570 TX Primary

Addresses

Primary practice location

8200 Walnut Hill LN
Dallas, TX 75231-4402

Mailing address

1140 Peacock Blvd
Carrollton, TX 75007-2943
Phone (469) 471-4848

Other practice location 1

1140 Peacock Blvd
Carrollton, TX 75007-2943
Phone (469) 471-4848

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20251219001724 TX Practitioner - Internal Medicine 1254826936 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hospitalist Medicine Physicians of Texas PLLCGroup PAC ID 3476688318, 685 clinicians

Practice addresses (Care Compare)

8200 Walnut Hill LN
Presbyterian Hospital Dallas
Dallas, TX 75231-4426
Phone (214) 345-6789

Hospital & facility affiliations

  • Texas Health Presbyterian Hospital Dallas Hospital, Dallas, TX, CCN 450462
  • Texas Health Presbyterian Hospital Rockwall Hospital, Rockwall, TX, CCN 670044
  • Texas Health Presbyterian Hospital Kaufman Hospital, Kaufman, TX, CCN 450292
  • Texas Health Presbyterian Hospital Flower Mound Hospital, Flower Mound, TX, CCN 670068

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
W0570TXMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hospitalist Medicine Physicians of Texas, PLLC Internal Medicine CurrentSince Oct 11, 2025 Accepting new patients

Locations

8200 Walnut Hill Ln
Dallas, TX 75231
Phone (214) 345-6148

18951 N Memorial Dr
Humble, TX 77338
Phone (281) 319-8409

Organizations & group practices 1

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1649894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765238400000",
    "number": "1649913138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1140 PEACOCK BLVD",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750072943",
            "telephone_number": "469-471-4848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8200 WALNUT HILL LN",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752314402",
            "telephone_number": "214-345-6176",
            "fax_number": "214-345-5167"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1140 Peacock Blvd",
            "address_purpose": "LOCATION",
            "city": "Carrollton",
            "state": "TX",
            "postal_code": "750072943",
            "country_code": "US",
            "telephone_number": "469-471-4848",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAN",
        "first_name": "ETHAN",
        "middle_name": "MATTHEW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-14",
        "last_updated": "2025-12-09",
        "certification_date": "2025-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "W0570",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.