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Ethan Edward Smith , PA-C

Physician Assistant β€’ Spooner, WI

Active NPI 1073215984 Individual Practitioner Male Practitioner Accepts Medicare assignment
Practice location in NPPES

1180 Chandler Dr
Spooner, WI 548012204

Call 7156352151 Location details and other listings
Medical Disclaimer

This profile restates public CMS/NPPES data; T-MedInfo gives no medical advice — consult a licensed professional, and call 911 for emergencies.

Practice Location & Contact Primary Location

Practice Address

1180 Chandler Dr

Spooner, WI 548012204

Telephone 7156352151
Organization at the Same NPPES Address or Phone
St Mary's Hospital Of Superior Facility NPI 1083161301

Matched by practice address or phone in NPPES. A shared address or phone does not confirm that this clinician works there.

Other Listings in Public Data

CMS Doctors and Clinicians lists 2 distinct group names: Advantage Physical Therapy And Sports Rehab, Llc; St Marys Hospital Of Superior. See the list

Source: CMS Doctors and Clinicians National Downloadable File, release date unavailable.

Listings do not confirm current availability, employment or a shared ownership network.

Medicare Profile & Education

Source: CMS Doctors and Clinicians National Downloadable File

Graduation Year

2024

Industry payments (Open Payments)

No Open Payments records are listed for this clinician for 2021–2025.

Guide: How to read an Open Payments record

Years since graduation

2 years (graduated 2024)

CMS Doctors and Clinicians data list 2024 as the year this clinician finished professional school.

What this does not show: Years since graduation

It is not the number of years in practice, and more years does not mean better care.

Source: CMS Doctors and Clinicians National Downloadable File.

NPI first issued

2023

The year this clinician's National Provider Identifier (NPI) was issued. An NPI is a unique 10-digit ID that US health care providers use for billing.

What this does not show: NPI first issued

NPIs have been issued only since 2005, so this year is not necessarily when the clinician started practicing.

Source: CMS NPPES NPI Registry.

Accepts Medicare assignment

CMS data list this clinician as accepting Medicare assignment. This means agreeing to take the Medicare-approved amount as full payment for covered services.

Medicare assignment applies to Original Medicare. It does not tell you whether the clinician is in a Medicare Advantage plan's network, accepts other insurance, or is taking new patients.

Source: CMS Doctors and Clinicians; Medicare.gov, β€œDoes your provider accept Medicare as full payment?”

Guide: What Medicare assignment means

No telehealth indicator

CMS shows this indicator only when recent Medicare claims include telehealth services. The clinician may still offer telehealth; ask the office.

Source: CMS, Telehealth Indicator on Medicare Care Compare (fact sheet, January 2023); CMS Doctors and Clinicians.

Guide: How Medicare covers telehealth

Enrolled in Medicare (PECOS)

Ethan Smith has a Medicare enrollment record in PECOS, the CMS system clinicians use to enroll so they can bill Medicare or order services for people with Medicare.

It does not show whether the clinician accepts assignment, is in your plan's network, or is taking new patients.

Source: CMS Medicare Fee-For-Service Public Provider Enrollment (PECOS); CMS Order and Referring file.

Guide: What Medicare enrollment (PECOS) means

Can order Medicare-covered services

CMS lists Ethan Smith as eligible to order or refer Medicare Part B clinical laboratory and imaging services, durable medical equipment (DME) and home health services for people with Medicare.

What this does not show: Can order Medicare-covered services

It does not mean the clinician offers these services directly.

Source: CMS Medicare Fee-For-Service Public Provider Enrollment (PECOS); CMS Order and Referring file.

Guide: What ordering and referring status means

Compared with the same specialty in Spooner and Wisconsin

2 active clinicians are listed under Physician Assistant with a practice address in Spooner, WI (3,476 in Wisconsin).

Addresses are self-reported to NPPES and may be out of date.

Sources: CMS Doctors and Clinicians, CMS NPPES NPI Registry. Specialty names follow the NUCC Health Care Provider Taxonomy.

Text: T-MedInfo Β· Report an error.

Specialties & License Numbers Reported to NPPES

Self-certified to NPPES: 2024-09-11
Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

License # reported to NPPES WI 8040

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Check License Status with the State Board License numbers are self-reported to NPPES; T-MedInfo does not confirm them against state records. Current status: Wisconsin Department of Safety and Professional Services.
Look Up on State Board Site

Medicare (PECOS) Enrollment & Ordering Eligibility

Source: CMS PECOS
Medicare FFS Enrollment Status Medicare Enrollment on File
CMS Provider Specialty

PRACTITIONER - PHYSICIAN ASSISTANT

Medicare Enrollment ID

I20240925000347

Enrollment State Jurisdiction

WI

PECOS Control ID

3375084783

Medicare Order & Referring Eligibility
Clinical Lab & Imaging (Part B) Eligible
Durable Medical Equipment (DME) Eligible
Home Health Agency (HHA) Eligible
Power Mobility Devices (PMD) Eligible

Sources: CMS Provider Enrollment and Order and Referring. Medicare enrollment is a billing status, not an accreditation or quality rating.

Medicare Group Practice Enrollments

Source: CMS Doctors and Clinicians National Downloadable File

St Marys Hospital Of Superior

1180 Chandler Dr, Spooner, WI 548012204

Phone: 7156352151

Advantage Physical Therapy And Sports Rehab, Llc

112 Ash St, Spooner, WI 548011487

Phone: 7156353979

St Marys Hospital Of Superior

819 Ash St, Spooner, WI 548011201

Phone: 7156355303

St Marys Hospital Of Superior

11134 N State Rd, Hayward, WI 548435325

Phone: 7156345505

Clinicians Sharing This Practice Address or Phone

Clinicians sharing this NPPES address, phone or fax; a shared contact does not mean they work together.

10 listed
NPI 1811939135

Doctor of Medicine (M.D.)

Bruce Bray

Family Medicine

NPI 1154458537
Dr. Brian Gaskill , DO

Family Medicine

NPI 1922062785

Doctor of Osteopathic Medicine (D.O.)

Dr. Roger Handtke , DO

Family Medicine

NPI 1396776589

Doctor of Osteopathic Medicine (D.O.)

NPI 1932380003

Doctor of Osteopathic Medicine (D.O.)

Kathleen Olsen

Nurse Practitioner - Women's Health

NPI 1881628196

Career & Practice History Timeline

Changes recorded in monthly NPPES data files: addresses, names, credentials, specialties and NPI status

10 Historical Events
πŸ“
Updated Practice Location September 11, 2024

Registered at 1180 CHANDLER DR, SPOONER, WI 548012204 (Tel: 7156352151)

πŸ“
Updated Business Mailing Address September 11, 2024

Registered at 400 E 3RD ST, DULUTH, MN 558051951 (Tel: 2187868364)

πŸ‘€
Provider Name / Credentials Updated September 11, 2024

Recorded as ETHAN SMITH, PA-C

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) September 11, 2024

Physician Assistant (license number reported to NPPES: WI 8040)

βœ…
NPI Profile Active March 22, 2023

NPI status registered as active in NPPES database

πŸ“
Practice Location (Initial Record) March 22, 2023

Registered at 3200 GRAND AVE, DES MOINES, IA 503124104 (Tel: 5152711569)

πŸ“
Business Mailing Address (Initial Record) March 22, 2023

Registered at 2626 15TH ST, RICE LAKE, WI 548689542 (Tel: 7152054351)

πŸ‘€
Provider Name / Credentials (Initial Record) March 22, 2023

Recorded as ETHAN SMITH

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) March 22, 2023

Student in an Organized Health Care Education/Training Program

🟒
Initial NPI Registration & Enumeration March 22, 2023

First registered as active Individual Practitioner in NPPES Database.

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NPI Administrative Meta

NPI Number: 1073215984
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: March 22, 2023
Last Update: September 11, 2024
Sole Proprietor: No

Mailing Address

400 E 3rd St

Duluth, MN 558051951

Phone: 2187868364

About This Data NPPES fields (address, phone, specialty, license) are self-reported and may be outdated; Medicare fields follow the CMS dataset named in each section. Correct directly at NPPES.