Individual provider Active NPI

Richard G Etra, M.D.

  • Otolaryngology Physician
  • Great Neck, NY
National Provider Identifier
1679558118
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
128003 Issued in NY
Practice address
560 Northern Blvd
Great Neck, NY 11021-5100
Phone
(516) 487-6200
Fax
(516) 487-6329
NPI assigned
Dec 7, 2005
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 128003 NY Primary

Addresses

Primary practice location

560 Northern Blvd
Great Neck, NY 11021-5100

Mailing address

175 Jericho Tpke
Syosset, NY 11791-4532
Phone (516) 622-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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 1

Enrollment IDStateProvider typePAC IDDetails
I20041014000435 NY Practitioner - Otolaryngology 7012977044 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Tufts University School of Medicine, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New York Allergy Asthma and Immunology PCGroup PAC ID 6507127750, 12 clinicians

Practice addresses (Care Compare)

560 Northern Blvd
Suite 104
Great Neck, NY 11021-5100
Phone (516) 487-6200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.58 of 100Reported as group
Quality
100
Improvement activities
40
Cost
78.61

National Provider Directory

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

Organizations & group practices 2

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.

Hospital & facility affiliations 1

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": "1133913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1679558118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 JERICHO TPKE",
            "city": "SYOSSET",
            "state": "NY",
            "postal_code": "117914532",
            "telephone_number": "516-622-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 NORTHERN BLVD",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110215100",
            "telephone_number": "516-487-6200",
            "fax_number": "516-487-6329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETRA",
        "first_name": "RICHARD",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-07",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NY",
            "license": "128003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Neck, NY

Sources for this page

Verify at the official NPI Registry.