David J Etzel, CNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

NP12090 Issued in OH

Practice address

31 E Main St
Shelby, OH 44875-1262

Phone

(419) 525-6795

Fax

(419) 525-6723

NPI assigned

Jan 11, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OH

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

Specialty

Nurse Practitioner

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Third Street Community Clinic, Inc.Group PAC ID 2365423977, shared by 13 NPIs, 29 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ohiohealth Shelby Hospital Hospital, Shelby, OH, CCN 361324
• Ohiohealth Mansfield Hospital Hospital, Mansfield, OH, CCN 360118

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner

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.

• Third Street Community Clinic Inc

  dba Shelby Health and Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Shelby, OH
  • NPI 1811364706
  Medicare reassignment NPD
• Third Street Community Clinic, Inc

  dba Cline Avenue Health and Wellness

  • Federally Qualified Health Center (FQHC)
  • Mansfield, OH
  • NPI 1720407554
  Medicare reassignment NPD
• Third Street Community Clinic, Inc.

  dba Malabar Care Connect

  • Federally Qualified Health Center (FQHC)
  • Mansfield, OH
  • NPI 1306499314
  Medicare reassignment NPD
• Third Street Community Clinic, Inc.

  dba Bucyrus Health and Wellness

  • Federally Qualified Health Center (FQHC)
  • Bucyrus, OH
  • NPI 1629620109
  Medicare reassignment NPD
• Third Street Community Clinic, Inc.

  dba Cornerstone OB/GYN

  • Federally Qualified Health Center (FQHC)
  • Mansfield, OH
  • NPI 1649599119
  Medicare reassignment NPD
• Third Street Community Clinic, Inc.

  dba Ashland Health and Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Ashland, OH
  • NPI 1104461805
  NPD
• Third Street Community Clinic, Inc

  dba Cornerstone OB/GYN

  • Primary Care Clinic/Center
  • Mansfield, OH
  • NPI 1558576116
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Medcentral Health System

  • Critical Access Hospital
  • Mansfield, OH
  • NPI 1487706016
  Care Compare affiliation
• Medcentral Health System

  • General Acute Care Hospital
  • Mansfield, OH
  • NPI 1790837235
  Care Compare affiliation
• Medcentral Health System

  dba Mansfield Laboratory Services

  • Clinical Medical Laboratory
  • Mansfield, OH
  • NPI 1962888016

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1294704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621987200000",
    "number": "1881999555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 W. THIRD STREET",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449062633",
            "telephone_number": "419-522-6191",
            "fax_number": "419-526-7939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 E MAIN ST",
            "city": "SHELBY",
            "state": "OH",
            "postal_code": "448751262",
            "telephone_number": "419-525-6795",
            "fax_number": "419-525-6723"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 W. Third Street",
            "address_purpose": "LOCATION",
            "city": "Mansfield",
            "state": "OH",
            "postal_code": "449062633",
            "country_code": "US",
            "telephone_number": "419-522-6191",
            "fax_number": "419-526-7939",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ETZEL",
        "first_name": "DAVID",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-01-11",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "12090-NP",
            "primary": false
        },
        {
            "code": "363LC1500X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Community Health",
            "state": "OH",
            "license": "12090-NP",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "NP12090",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "12090-NP",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3110449",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "detzel227698@direct.ohiohealth.com",
            "affiliation": "Y",
            "affiliationName": "Third Street Community Clinic, Inc.",
            "address_1": "31 E Main St",
            "city": "Shelby",
            "state": "OH",
            "country_code": "US",
            "postal_code": "448751262",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Kelsie M Fannin
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• Robert Fighter

• Family Nurse Practitioner in Shelby, OH
• Providers in Shelby, OH by specialty
• Family Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2021; 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.