MR. ETHAN EDWARD SMITH PA-C
NPI 1073215984
Physician Assistant in Spooner, WI

Active since March 22, 2023PECOS EnrolledAccepts Medicare Assignment
1180 CHANDLER DR, SPOONER, WI 54801(715) 635-2151 Get Directions Write a Review

NPPES record last updated: September 11, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Sep 11, 2024, Mar 22, 2023 (2 updates tracked since 2023).

About Mr. Ethan Edward Smith Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. ETHAN EDWARD SMITH PA-C (NPI 1073215984) is an individual physician assistant in Spooner, Wisconsin, licensed in Wisconsin (8040) and active in the NPI registry since March 2023. He is enrolled in Medicare PECOS, is affiliated with St Marys Hospital Superior, and is a graduate of Other (2024).

NPPES Registry Identity

NPI1073215984
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameMR. ETHAN EDWARD SMITHCredential: PA-C
Location Address1180 CHANDLER DRSpooner, WI 54801-2204
Mailing Address400 E 3rd StDuluth, MN 55805-1951 · (218) 786-8364
Sole ProprietorNo
Medical School CMSOtherGraduated 2024
Enumeration DateMarch 22, 2023
Last NPPES UpdateSeptember 11, 20242 updates tracked since enumeration
NPPES CertifiedSeptember 11, 2024
NPI 1073215984 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License Licensed in WI · 8040
Definition

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.

1180 CHANDLER DR, Spooner, WI 54801

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Mr. Ethan Edward Smith Pa-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3375084783
PECOS Enrollment IDI20240925000347
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare 4

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

St Marys Hospital Superior

Critical Access Hospitals · Superior, WI
OwnershipVoluntary non-profit - Private
CMS Certification Number521329
Location3500 Tower AveSuperior, WI 54880 · Douglas County
Emergency services

Spooner Health System

Critical Access Hospitals · Spooner, WI
OwnershipVoluntary non-profit - Private
CMS Certification Number521332
Location1280 Chandler DrSpooner, WI 54801 · Washburn County
Emergency services

Tamarack Health Hayward Medical Center

Critical Access Hospitals · Hayward, WI
OwnershipVoluntary non-profit - Private
CMS Certification Number521336
Location11040 N State Rd 77Hayward, WI 54843 · Sawyer County
Emergency services

Indianhead Medical Ctr

Critical Access Hospitals · Shell Lake, WI
OwnershipProprietary
CMS Certification Number521342
Location113 4th AveShell Lake, WI 54871 · Washburn County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 54801 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$82.92 typical visit price
range $53.90 – $163.24
Typical copayment $20.73 (range $13.47 – $40.81)
Most-billed visit code 99203
Established Patient
$67.37 typical visit price
range $17.40 – $133.76
Typical copayment $16.84 (range $4.35 – $33.44)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Family Medicine
1180 CHANDLER DR
SPOONER, WI 54801
Nurse Practitioner (Adult Health)
1180 CHANDLER DR
SPOONER, WI 54801
Nurse Practitioner (Family)
1180 CHANDLER DR
SPOONER, WI 54801
Family Medicine
1180 CHANDLER DR
SPOONER, WI 54801

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ethan Smith's NPI number?

The NPI number for Ethan Smith is 1073215984. It was assigned to this individual provider in the NPPES registry on March 22, 2023.

Where is Ethan Smith located?

Ethan Smith practices at 1180 Chandler Dr, Spooner, WI 54801. The listed phone number is (715) 635-2151.

What is Ethan Smith's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Ethan Smith enrolled in Medicare?

Yes. Ethan Smith is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Ethan Smith accept?

Health plans from Anthem Blue Cross and Blue Shield, HealthPartners, Medica, Sanford Health Plan and Security Health Plan list Ethan Smith as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Ethan Smith affiliated with any hospitals?

According to CMS data, Ethan Smith is affiliated with St Marys Hospital Superior, Spooner Health System, Tamarack Health Hayward Medical Center and Indianhead Medical Ctr.

When was this NPI record last updated?

The NPPES record for Ethan Smith was last updated on September 11, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.