Dr Ethan Roy Etnyre, MD is a medicare enrolled "Family Medicine" physician in Oceano, California. His current practice location is
2120 Cienaga St, Oceano, California. You can reach out to his office (for appointments etc.) via phone at
(805) 994-2100.
Dr Ethan Roy Etnyre is licensed to practice in California (license number G073939) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1225021777.
Physician's Profile
| Full Name | Dr Ethan Roy Etnyre |
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| Gender | Male |
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| Speciality | Family Medicine |
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| Location | 2120 Cienaga St, Oceano, California |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1225021777
- Provider Enumeration Date: 08/30/2005
- Last Update Date: 11/07/2017
Medicare PECOS Information:
- PECOS PAC ID: 1557559770
- Enrollment ID: I20110916000270
Medical Identifiers
Medical identifiers for Dr Ethan Roy Etnyre such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1225021777 | NPI | - | NPPES |
| CB207800 | Other | CA | MEDICARE ID |
| 080142806 | Other | | RAILROAD MEDICARE |
| 00G739390 | Other | CA | BLUE SHIELD OF CALIFORNIA |
| 00G739390 | Medicaid | CA | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207Q00000X | Family Medicine | G073939 (California) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Ethan Roy Etnyre allows following entities to bill medicare on his behalf.
| Entity Name | Community Health Centers Of The Central Coast Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1336166248
PECOS PAC ID: 7416868120
Enrollment ID: O20040115001161 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Ethan Roy Etnyre is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Dr Ethan Roy Etnyre, MD
2050 S Blosser Rd,
Santa Maria, CA 93458-7310
Ph: (805) 361-8028 | Dr Ethan Roy Etnyre, MD
2120 Cienaga St,
Oceano, CA 93445-9016
Ph: (805) 994-2100 |
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