Ethan D Nguyen, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

F09190130 Issued in AZ

Practice address

13065 W McDowell Rd Ste A105
Avondale, AZ 85392-6440

Phone

(623) 536-6788

Fax

(235) 369-2886

NPI assigned

May 10, 2018

Last updated

Oct 21, 2020By the provider in NPPES

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

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in AZ

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

Specialty

Family Practice

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Spectrum Medical Care CenterGroup PAC ID 9739590076, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Spectrum Medical Care Center

  • Medical Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1417433236

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Westview Family Medicine, P.C.

  • Family Medicine Physician
  • Avondale, AZ
  • NPI 1922204155

  Single Specialty

  Medicare reassignment NPD

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

{
    "created_epoch": "1525910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603238400000",
    "number": "1821587346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13065 W MCDOWELL RD STE A105",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853926440",
            "telephone_number": "623-536-6788",
            "fax_number": "623-536-9288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13065 W MCDOWELL RD STE A105",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853926440",
            "telephone_number": "623-536-6788",
            "fax_number": "235-369-2886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "ETHAN",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-05-10",
        "last_updated": "2020-10-21",
        "certification_date": "2020-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "F09190130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Elation",
            "affiliation": "N",
            "endpointDescription": "Elation",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "10631 S 51st St Ste 1-3",
            "city": "Phoenix",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "850445225",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "ethan@chollamedical.com",
            "affiliation": "N",
            "endpointDescription": "Direct Email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "10631 S 51st St Ste 1-3",
            "city": "Phoenix",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "850445225",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• William Newman
• Newspring Pharmacy LLC (NewSpring Pharmacy)
• Nextcare Arizona LLC
• Andrew Mambo Ngigi
• Khanh Ngo, OD
• Lam Thanh Nguyen
• Lily Nguyen, PHARMD
• Nam-Rene Nguyen, DDS
• Olivia Thuy Nguyen, PA-C
• Son T Nguyen, DDS

• Family Nurse Practitioner in Avondale, AZ
• Providers in Avondale, AZ by specialty
• Family Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2020; 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.