NPIMap

Individual provider Active NPI

Michael Van Etten, PA-C

  • Physician Assistant
  • Phoenixville, PA
National Provider Identifier
1770124539
Registry record updated Oct 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA060871 Issued in PA
Practice address
140 Nutt Rd
Phoenixville, PA 19460-3906
Phone
(610) 983-1223
Fax
(610) 983-1717
NPI assigned
Oct 3, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA060871 PA Primary

Addresses

Primary practice location

140 Nutt Rd
Phoenixville, PA 19460-3906

Mailing address

PO Box 13579
Reading, PA 19612-3579
Phone (484) 628-4948

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20200228001741 PA Practitioner - Physician Assistant 8921435140 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tower Health Medical GroupGroup PAC ID 7618889213, 578 clinicians

Practice addresses (Care Compare)

2610 Keiser Blvd
Wyomissing, PA 19610-3333
Phone (484) 750-3950

301 S 7TH Ave
Radiology Tower Health Medical Group
West Reading, PA 19611-1442
Phone (484) 628-8112

420 S 5TH Ave
West Reading, PA 19611-2143

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.71 of 100Reported as group
Quality
73.34
Promoting interoperability
97
Improvement activities
40
Cost
78.18

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA060871PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Tower Health Medical Group CurrentSince Mar 1, 2022 Accepting new patients
Reading Hospital CurrentSince Jun 23, 2022 Accepting new patients
Tower Health Medical Group CurrentSince Mar 1, 2022 Accepting new patients
Phoenixville Clinic Company LLC CurrentSince Jan 15, 2020 Accepting new patients
Reading Hospital CurrentSince Jun 23, 2022 Accepting new patients
Pottstown Hospital, LLC Past Accepting new patients
Pottstown Hospital, LLC Past Accepting new patients

Locations

140 Nutt Rd
Phoenixville, PA 19460
Phone (610) 983-1000

301 S 7th Ave
Ste 130
West Reading, PA 19611
Phone (610) 988-4630

206 S 6th Ave
West Reading, PA 19611
Phone (484) 628-5437

2610 Keiser Blvd
Wyomissing, PA 19610
Phone (484) 628-9127

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1606/brand/1/csg/101/fhir/r4

Organizations & group practices 11

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 6

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": "1570060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570060800000",
    "number": "1770124539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13579",
            "city": "READING",
            "state": "PA",
            "postal_code": "196123579",
            "telephone_number": "484-628-4948",
            "fax_number": "484-334-7026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 NUTT RD",
            "city": "PHOENIXVILLE",
            "state": "PA",
            "postal_code": "194603906",
            "telephone_number": "610-983-1223",
            "fax_number": "610-983-1717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN ETTEN",
        "first_name": "MICHAEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-03",
        "last_updated": "2019-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA060871",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenixville, PA

Sources for this page

Verify at the official NPI Registry.