NPIMap

Individual provider Active NPI

Ethan John Mytinger

  • Physician Assistant
  • Denver, CO
National Provider Identifier
1932753100
Registry record updated Sep 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1601 E 19TH Ave Ste 5500
Denver, CO 80218-1291
Phone
(303) 777-7112
Fax
(303) 722-7010
NPI assigned
Jul 26, 2019
Last updated
Sep 1, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 1, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU Primary

Addresses

Primary practice location

1601 E 19TH Ave Ste 5500
Denver, CO 80218-1291

Mailing address

3333 S Bannock St Ste 350
Englewood, CO 80110-2426
Phone (303) 957-1310

Other practice location 1

1400 S Potomac St Ste 120
Aurora, CO 80012-4514
Phone (303) 777-7112

Other identifiers 2

IdentifierTypeStateIssuer
6000000003748572MedicaidWI
9000181996MedicaidCO

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL aspirus.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200629001030 CO Practitioner - Physician Assistant 0446672026 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Rocky Mountain Gastroenterology Associates, PLLCGroup PAC ID 5991797532, 37 clinicians

Practice addresses (Care Compare)

10001 Washington St
Thornton, CO 80229-2050
Phone (303) 252-4442

355 Union Blvd
Suite 200
Lakewood, CO 80228-1500
Phone (303) 463-3900

Hospital & facility affiliations

National Provider Directory

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

Organizations & group practices 1

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 12

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": "1564099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661990400000",
    "number": "1932753100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 S BANNOCK ST STE 350",
            "city": "ENGLEWOOD",
            "state": "CO",
            "postal_code": "801102426",
            "telephone_number": "303-957-1310",
            "fax_number": "303-761-4252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 E 19TH AVE STE 5500",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802181291",
            "telephone_number": "303-777-7112",
            "fax_number": "303-722-7010"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 S Potomac St Ste 120",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "CO",
            "postal_code": "800124514",
            "country_code": "US",
            "telephone_number": "303-777-7112",
            "fax_number": "303-722-7010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MYTINGER",
        "first_name": "ETHAN",
        "middle_name": "JOHN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-07-26",
        "last_updated": "2022-09-01",
        "certification_date": "2022-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6000000003748572",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000181996",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "aspirus.org",
            "affiliation": "N",
            "address_1": "164783 River Rd",
            "city": "Ringle",
            "state": "WI",
            "country_code": "US",
            "postal_code": "544715892",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Denver, CO

Sources for this page

Verify at the official NPI Registry.