Gregory Etienne, PHYSICIAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10192 Issued in AZ

Practice address

126 S Coronado Dr Ste B
Sierra Vista, AZ 85635-6300

Phone

(786) 618-8554

NPI assigned

Nov 7, 2022

Last updated

Jun 4, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Gregory Etienne Other name

Medicare fee-for-service enrollment

Enrolled in AZ

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

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Keyamed, Inc a P CGroup PAC ID 6103976642, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Copper Queen Community Hospital Hospital, Bisbee, AZ, CCN 031312

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gregory.etienne.1@15495.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Keyamed, Inc a P C

  dba DBA New Era Family Practice

  • Geriatric Medicine (Family Medicine) Physician
  • Sierra Vista, AZ
  • NPI 1417181348
  Medicare reassignment Care Compare group
• West Coast Wound and Skin Care Inc

  • Surgery Physician
  • Burbank, CA
  • NPI 1437675980

  AZ

  Medicare reassignment NPD

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

• Bisbee Hospital Association

  • Critical Access Hospital
  • Bisbee, AZ
  • NPI 1518968767
  Care Compare affiliation

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

{
    "created_epoch": "1667779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717459200000",
    "number": "1669180915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 JOAN ST",
            "city": "WILBRAHAM",
            "state": "MA",
            "postal_code": "010952035",
            "telephone_number": "786-618-8554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 S CORONADO DR STE B",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856356300",
            "telephone_number": "786-618-8554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETIENNE",
        "first_name": "GREGORY",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-11-07",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PR",
            "license": "1447",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "10192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GREGORY",
            "last_name": "ETIENNE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Envision Anesthesia Services of Sierra Vista, Inc.
• Barbara Ann Ernst-Bustamante
• Maria Audrey Erspamer, APRN, PMHNP-BC
• Marcus Robert Eschelbach, DO
• Elizabeth Estrada, LPN
• Judith Evans, RPH
• Nathaniel D. Evans, D.O
• Morgan Paul Evershed, D.D.S.
• Eyeflyaz, Inc (Phillips Eye Care)
• Eyemart Express LLC

• Physician Assistant in Sierra Vista, AZ
• Providers in Sierra Vista, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.