Individual provider Active NPI

Ethan Wallace Rhone, PA-C

  • Medical Physician Assistant
  • Pensacola, FL
National Provider Identifier
1821090093
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA9100907 Issued in FL
Practice address
1619 Creighton Rd Ste 1
Pensacola, FL 32504-7152
Phone
(850) 444-4700
Fax
(850) 434-8144
NPI assigned
Jun 1, 2005
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9100907 FL
Medical Physician Assistant 363AM0700X PA9100907 FL Primary

Addresses

Primary practice location

1619 Creighton Rd Ste 1
Pensacola, FL 32504-7152

Mailing address

PO Box 11037
Pensacola, FL 32524-1037
Phone (850) 444-7000

Other practice location 1

319 Green Acres Rd Ste 103
Fort Walton Beach, FL 32547-1170
Phone (850) 862-2385

Other practice location 2

2940 N Blue Angel Pkwy
Pensacola, FL 32506-2925
Phone (850) 444-4700

Other practice location 3

14114 Alabama St
Jay, FL 32565-1219
Phone (850) 444-4700

Other practice location 4

221 E Redstone Ave
Crestview, FL 32539-5373
Phone (850) 398-6606

Other practice location 5

6001 Industrial Blvd
Century, FL 32535-3312
Phone (850) 444-4700

Other practice location 6

5149 N 9th Ave Ste G35
Pensacola, FL 32504-8733
Phone (850) 444-4700

Other practice location 7

4304 Lancaster Dr
Niceville, FL 32578-4563
Phone (850) 862-2385

Other practice location 8

5934 Berryhill Medical Park Dr # 1
Milton, FL 32570
Phone (850) 623-4771

Other practice location 9

1717 N E St Ste 403
Pensacola, FL 32501-6334
Phone (850) 444-4700

Other practice location 10

2583 Gulf Breeze Pkwy
Gulf Breeze, FL 32563
Phone (850) 444-4700

Other identifiers 2

IdentifierTypeStateIssuer
PA9100907OtherFLFLORIDA STATE DOH - MEDICAL LICENSURE
291142600MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, AL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20080509000016 FL Practitioner - Physician Assistant 1153409180 Reassigns benefits to 3 organizations
I20250820000691 AL Practitioner - Physician Assistant 1153409180 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pensacola Nephrology PAGroup PAC ID 7214832856, 37 clinicians

Practice addresses (Care Compare)

1121 Belleview Ave
Brewton, AL 36426-1500
Phone (850) 444-4700

1619 Creighton Rd
Suite 1
Pensacola, FL 32504-7152
Phone (850) 444-4700

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9100907FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Pensacola Nephrology, PA CurrentSince Jun 29, 2015 Accepting new patients
Pensacola Nephrology, PA CurrentSince Jun 29, 2015 Accepting new patients
Tri Hospital MRI Center Past Accepting new patients
Renal Care Group of the Southeast, Inc. Past Accepting new patients
Pensacola Nephrology, PA Past Accepting new patients
Pensacola Family Practice PastSince Oct 18, 1999 Accepting new patients

Locations

401 S 8th Ave
Atmore, AL 36502
Phone (251) 368-2500

807 E Craig St
Atmore, AL 36502
Phone (251) 368-5593

1023 Douglas Ave
Ste 300
Brewton, AL 36426
Phone (251) 867-8509

1121 Belleville Ave
Brewton, AL 36426
Phone (251) 809-3180

6001 Industrial Blvd
Century, FL 32535
Phone (251) 943-2300

221 E Redstone Ave
Crestview, FL 32539
Phone (850) 398-6606

319 Green Acres Rd
#103
Fort Walton Beach, FL 32547

2583 Gulf Breeze Pkwy
Gulf Breeze, FL 32563
Phone (850) 934-1951

14114 Alabama St
Jay, FL 32565
Phone (850) 675-8000

4304 Lancaster Dr
Niceville, FL 32578
Phone (850) 729-4141

1619 Creighton Rd
Ste 1
Pensacola, FL 32504
Phone 85044447001730

1717 N E St
Ste 403
Pensacola, FL 32501

2940 N Blue Angel Pkwy
Pensacola, FL 32506
Phone (850) 453-3658

5149 N 9th Ave
Ste G35
Pensacola, FL 32504
Phone (850) 471-1445

Organizations & group practices 8

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": "1117584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1821090093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11037",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325241037",
            "telephone_number": "850-444-7000",
            "fax_number": "850-444-7497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1619 CREIGHTON RD STE 1",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325047152",
            "telephone_number": "850-444-4700",
            "fax_number": "850-434-8144"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "319 Green Acres Rd Ste 103",
            "address_purpose": "LOCATION",
            "city": "Fort Walton Beach",
            "state": "FL",
            "postal_code": "325471170",
            "country_code": "US",
            "telephone_number": "850-862-2385",
            "fax_number": "850-862-0482",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2940 N Blue Angel Pkwy",
            "address_purpose": "LOCATION",
            "city": "Pensacola",
            "state": "FL",
            "postal_code": "325062925",
            "country_code": "US",
            "telephone_number": "850-444-4700",
            "fax_number": "850-434-8144",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14114 Alabama St",
            "address_purpose": "LOCATION",
            "city": "Jay",
            "state": "FL",
            "postal_code": "325651219",
            "country_code": "US",
            "telephone_number": "850-444-4700",
            "fax_number": "850-434-8144",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "221 E Redstone Ave",
            "address_purpose": "LOCATION",
            "city": "Crestview",
            "state": "FL",
            "postal_code": "325395373",
            "country_code": "US",
            "telephone_number": "850-398-6606",
            "fax_number": "850-398-6424",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6001 Industrial Blvd",
            "address_purpose": "LOCATION",
            "city": "Century",
            "state": "FL",
            "postal_code": "325353312",
            "country_code": "US",
            "telephone_number": "850-444-4700",
            "fax_number": "850-434-8144",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5149 N 9th Ave Ste G35",
            "address_purpose": "LOCATION",
            "city": "Pensacola",
            "state": "FL",
            "postal_code": "325048733",
            "country_code": "US",
            "telephone_number": "850-444-4700",
            "fax_number": "850-434-8144",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4304 Lancaster Dr",
            "address_purpose": "LOCATION",
            "city": "Niceville",
            "state": "FL",
            "postal_code": "325784563",
            "country_code": "US",
            "telephone_number": "850-862-2385",
            "fax_number": "850-862-0482",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5934 Berryhill Medical Park Dr # 1",
            "address_purpose": "LOCATION",
            "city": "Milton",
            "state": "FL",
            "postal_code": "32570",
            "country_code": "US",
            "telephone_number": "850-623-4771",
            "fax_number": "850-623-3938",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1717 N E St Ste 403",
            "address_purpose": "LOCATION",
            "city": "Pensacola",
            "state": "FL",
            "postal_code": "325016334",
            "country_code": "US",
            "telephone_number": "850-444-4700",
            "fax_number": "850-434-8144",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2583 Gulf Breeze Pkwy",
            "address_purpose": "LOCATION",
            "city": "Gulf Breeze",
            "state": "FL",
            "postal_code": "32563",
            "country_code": "US",
            "telephone_number": "850-444-4700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RHONE",
        "first_name": "ETHAN",
        "middle_name": "WALLACE",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-01",
        "last_updated": "2022-07-21",
        "certification_date": "2021-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9100907",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9100907",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA STATE DOH - MEDICAL LICENSURE",
            "identifier": "PA9100907",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291142600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pensacola, FL

Sources for this page

Verify at the official NPI Registry.