NPIMap

Individual provider Active NPI

Babak Etemad, MD

  • Gastroenterology Physician
  • Wynnewood, PA
National Provider Identifier
1942268057
Registry record updated Jun 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
MD049259L Issued in PA
Practice address
100 E Lancaster Ave Ste 560
Wynnewood, PA 19096
Phone
(484) 476-8390
Fax
(484) 476-7841
NPI assigned
May 1, 2006
Last updated
Jun 29, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 29, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X MD049259L PA Primary

Addresses

Primary practice location

100 E Lancaster Ave Ste 560
Wynnewood, PA 19096

Mailing address

100 E Lancaster Ave Ste 560
Wynnewood, PA 19096-3450
Phone (484) 476-8390

Other identifiers 1

IdentifierTypeStateIssuer
1185345MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, CO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050621000308 PA Practitioner - Gastroenterology 4880639863 Reassigns benefits to 1 organization
I20241209002703 CO Practitioner - Gastroenterology 4880639863 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Temple University School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Valley View Hospital AssociationGroup PAC ID 1850294778, 205 clinicians

Practice addresses (Care Compare)

1830 Blake Ave
Suite 207
Glenwood Springs, CO 81601-4261
Phone (970) 384-7510

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy193
Upper gastrointestinal (GI) endoscopy for acid reflux358

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD049259LPAMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Valley View Hospital Association CurrentSince Dec 1, 2024 Accepting new patients
Valley View Hospital Association Gastroenterology CurrentSince Dec 1, 2024 Accepting new patients
Valley View Hospital Association Current Accepting new patients
Main Line Healthcare CurrentSince Jan 1, 2018 Accepting new patients
Valley View Hospital Association Past Accepting new patients

Locations

1906 Blake Ave
Glenwood Springs, CO 81601
Phone (970) 384-7033

1830 Blake Ave
Ste 207
Glenwood Springs, CO 81601
Phone (602) 387-4035

830 Old Lancaster Rd
Ste 108
Bryn Mawr, PA 19010
Phone (610) 520-5200

100 E Lancaster Ave
Ste 252E
Wynnewood, PA 19096

100 E Lancaster Ave
Ste 252
Wynnewood, PA 19096
Phone (610) 896-7360

100 E Lancaster Ave
Ste 560
Wynnewood, PA 19096
Phone (484) 476-8390

Interoperability endpoints

  • Direct secure messaging: babak.etemad.1@9028.direct.athenahealth.com

Organizations & group practices 6

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 8

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": "1146441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530230400000",
    "number": "1942268057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E LANCASTER AVE STE 560",
            "city": "WYNNEWOOD",
            "state": "PA",
            "postal_code": "190963450",
            "telephone_number": "484-476-8390",
            "fax_number": "484-476-7841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E LANCASTER AVE STE 560",
            "city": "WYNNEWOOD",
            "state": "PA",
            "postal_code": "19096",
            "telephone_number": "484-476-8390",
            "fax_number": "484-476-7841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETEMAD",
        "first_name": "BABAK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-01",
        "last_updated": "2018-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "PA",
            "license": "MD049259L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1185345",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wynnewood, PA

Sources for this page

Verify at the official NPI Registry.