Ethan Lawrence Smith

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA1750164752 Issued in WA

Practice address

1123 N Evergreen Rd
Spokane Valley, WA 99216-1138

Phone

(509) 363-3100

Fax

(509) 363-0300

NPI assigned

Aug 15, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

T Daniel Dibble MD PCGroup PAC ID 1254320922, 12 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Newport Community Hospital Hospital, Newport, WA, CCN 501310
• Providence Mount Carmel Hospital Hospital, Colville, WA, CCN 501326

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• T Daniel Dibble MD PC

  dba Spine Team Spokane

  • Interventional Pain Medicine Physician
  • Spokane Valley, WA
  • NPI 1780754499

  Multi-Specialty

  Medicare reassignment Care Compare group NPD
• T Daniel Dibble MD PC

  dba Spine Team Spokane

  • Interventional Pain Medicine Physician
  • Spokane, WA
  • NPI 1346082344

  Multi-Specialty

  NPD

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

• Pend Oreille County Public Hospital District No 1

  dba Newport Community Hospital

  • Critical Access Hospital
  • Newport, WA
  • NPI 1780778423
  Care Compare affiliation
• Providence Health & Services - Washington

  dba Providence Mount Carmel Hospital

  • Critical Access Hospital
  • Colville, WA
  • NPI 1003067679
  Care Compare affiliation

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

{
    "created_epoch": "1692057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761782400000",
    "number": "1750164752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 808",
            "city": "VERADALE",
            "state": "WA",
            "postal_code": "990370808",
            "telephone_number": "509-363-3100",
            "fax_number": "509-363-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1123 N EVERGREEN RD",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992161138",
            "telephone_number": "509-363-3100",
            "fax_number": "509-363-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "ETHAN",
        "middle_name": "LAWRENCE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-08-15",
        "last_updated": "2025-10-30",
        "certification_date": "2025-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA1750164752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna J Smith
• Ashley Marie Smith, NP
• Brandon Michael Smith, PA C
• Coleen E Smith, LAC
• Crystal Amber Smith, BA
• Halle Smith
• Holly Emma Smith, P.T
• Jennifer L Smith, CDP
• Julie Marie Smith, LMP
• Kaitlin Anna Smith

• Physician Assistant in Spokane Valley, WA
• Providers in Spokane Valley, WA by specialty
• Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2025; 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.