Donald R Ebersole, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01042385A Issued in IN

Practice address

8609 Evergreen Way
Everett, WA 98208-2619

Phone

(425) 258-1830

NPI assigned

Jan 25, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CO

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, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Valley-Wide Health Systems, Inc.Group PAC ID 5991609067, 42 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kaiser Foundation Hospital Hospital, Honolulu, HI, CCN 120011
• San Luis Valley Health Conejos County Hospital Hospital, La Jara, CO, CCN 061308
• Arkansas Valley Regional Medical Center Hospital, Lajuna, CO, CCN 061336

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: donald.ebersole.p1@direct.vwhs.nextgenshare.com

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.

• Valley-Wide Health Systems, Inc

  • Federally Qualified Health Center (FQHC)
  • Alamosa, CO
  • NPI 1790998953
  Medicare reassignment Care Compare group NPD
• Hawaii Permanente Medical Group Inc

  • Health Maintenance Organization
  • Honolulu, HI
  • NPI 1710945969
  NPD
• Valley-Wide Health Systems, Inc.

  dba Rock Creek Family Medicine

  • Federally Qualified Health Center (FQHC)
  • Alamosa, CO
  • NPI 1205652047
  NPD
• Lima Memorial Joint Operating Company

  dba Lima Memorial Health System

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)
• Valley-Wide Health Systems, Inc.

  dba Valley-Wide Canon City

  • Federally Qualified Health Center (FQHC)
  • Canon City, CO
  • NPI 1215383500
  NPD (past)

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

• Arkansas Valley Regional Medical Center

  • Critical Access Hospital
  • La Junta, CO
  • NPI 1760489470
  Care Compare affiliation
• Kaiser Foundation Hospitals

  • General Acute Care Hospital
  • Honolulu, HI
  • NPI 1396813861
  Care Compare affiliation
• Lutheran Hospital Association of the San Luis Valley

  dba SLV Health Conejos County Hospital

  • Critical Access Hospital Clinic/Center
  • La Jara, CO
  • NPI 1194792762
  Care Compare affiliation

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733788800000",
    "number": "1932179587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "814 BAINBRIDGE PL",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465265527",
            "telephone_number": "574-536-2541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8609 EVERGREEN WAY",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982082619",
            "telephone_number": "425-258-1830"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2014 S Main St",
            "address_2": "Suite B",
            "address_purpose": "LOCATION",
            "city": "Goshen",
            "state": "IN",
            "postal_code": "465265220",
            "country_code": "US",
            "telephone_number": "574-533-8639",
            "fax_number": "574-533-9542",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EBERSOLE",
        "first_name": "DONALD",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-25",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01042385A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100377500",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "donald.ebersolemd.p1@direct.goshenphysicians.nextgenshare.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "2014 S Main St",
            "address_2": "Suite B",
            "city": "Goshen",
            "state": "IN",
            "country_code": "US",
            "postal_code": "465265220",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• April Echauri, CPC
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• Eckland and Eckland PLLC (Eckland Family Dentistry- Redmond)

• Family Medicine Physician in Everett, WA
• Providers in Everett, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2024; 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.