NPIMap

Individual provider Active NPI

Ethan Bernell Dalley, M.D.

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Lubbock, TX
National Provider Identifier
1780818112
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
License
P9063 Issued in TX
Practice address
3419 22ND St
Lubbock, TX 79410
Phone
(806) 796-3000
Fax
(806) 796-3006
NPI assigned
May 13, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X P9063 TX Primary

Addresses

Primary practice location

3419 22ND St
Lubbock, TX 79410

Mailing address

3419 22ND St
Lubbock, TX 79410-1334
Phone (806) 796-3000

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
I20140730000502 TX Practitioner - Physical Medicine and Rehabilitation 8729236377 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Texas Tech University Health Science Center School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Neurosurgical Associates, PLLCGroup PAC ID 5890693402, 37 clinicians

Practice addresses (Care Compare)

3419 22ND St
Lubbock, TX 79410-1334
Phone (806) 796-3000

Hospital & facility affiliations

  • Covenant Medical Center Hospital, Lubbock, TX, CCN 450040
  • Grace Surgical Hospital Hospital, Lubbock, TX, CCN 450162
  • University Medical Center Hospital, Lubbock, TX, CCN 450686
  • Plains Regional Medical Center Hospital, Clovis, NM, CCN 320022
  • Covenant Health Hobbs Hospital Hospital, Hobbs, NM, CCN 320065

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
P9063TXMDPain Medicine (Physical Medicine & Rehabilitation) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Neurosurgical Associates, PLLC Multi-Specialty CurrentSince Aug 1, 2014 Accepting new patients

Locations

6826 Plum Creek Dr
Amarillo, TX 79124
Phone (806) 322-3000

3300 N A St
Bldg 5
Midland, TX 79705
Phone (432) 400-3401

Interoperability endpoints

  • Direct secure messaging: ethandalley@nhs.allscriptsdirect.net
  • Direct secure messaging: ethan.dalley@direct.myteamcare.com
  • Direct secure messaging: edalley@yourcarecommunity.org

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 9

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": "1242172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1780818112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3419 22ND ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101334",
            "telephone_number": "806-796-3000",
            "fax_number": "806-796-3006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3419 22ND ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "79410",
            "telephone_number": "806-796-3000",
            "fax_number": "806-796-3006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALLEY",
        "first_name": "ETHAN",
        "middle_name": "BERNELL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-05-13",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "TX",
            "license": "P9063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lubbock, TX

Sources for this page

Verify at the official NPI Registry.