Individual provider Active NPI

Ethan J Werner, PA-C

  • Medical Physician Assistant
  • Kennett Square, PA
National Provider Identifier
1831796556
Registry record updated Oct 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
300 Old Forge LN # 302
Kennett Square, PA 19348-1897
Phone
(484) 778-8000
NPI assigned
Oct 6, 2020
Last updated
Oct 6, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 6, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X NU Primary

Addresses

Primary practice location

300 Old Forge LN # 302
Kennett Square, PA 19348-1897

Mailing address

300 Old Forge LN # 302
Kennett Square, PA 19348-1897

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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

Enrollment IDStateProvider typePAC IDDetails
I20210204001917 PA Practitioner - Physician Assistant 0042624926 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lancaster General Medical GroupGroup PAC ID 0941103683, 590 clinicians

Practice addresses (Care Compare)

2118 Spring Valley Rd
Lancaster, PA 17601-2427
Phone (215) 615-2222

3045 Marietta Ave
Lancaster, PA 17601-1321
Phone (717) 299-4644

895 E Main St
Ephrata, PA 17522-2545

950 S Octorara Trail
Parkesburg, PA 19365-2100

950 S Octorara TRL
Parkesburg, PA 19365-2100

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lancaster General Medical Group Single Specialty CurrentSince Feb 19, 2024 Accepting new patients
Lancaster General Medical Group CurrentSince Feb 19, 2024 Accepting new patients
Lancaster General Medical Group Single Specialty Past Accepting new patients
Pennsylvania Urgent Care Centers, PLLC PastSince Aug 25, 2019 Accepting new patients

Locations

2118 Spring Valley Rd
Lancaster, PA 17601
Phone (215) 615-2222

3045 Marietta Ave
Lancaster, PA 17601
Phone (717) 299-4644

Organizations & group practices 7

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 3

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": "1601942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601942400000",
    "number": "1831796556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 OLD FORGE LN # 302",
            "city": "KENNETT SQUARE",
            "state": "PA",
            "postal_code": "193481897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 OLD FORGE LN # 302",
            "city": "KENNETT SQUARE",
            "state": "PA",
            "postal_code": "193481897",
            "telephone_number": "484-778-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WERNER",
        "first_name": "ETHAN",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-10-06",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennett Square, PA

Sources for this page

Verify at the official NPI Registry.