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ETHAN MATTHEW FAN
NPI 1649913138
Internal Medicine in Dallas, TX

Active since April 14, 2022PECOS EnrolledAccepts Medicare Assignment
8200 WALNUT HILL LN, DALLAS, TX 75231(214) 345-6176(214) 345-5167 Get Directions Write a Review

NPPES record last updated: December 9, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Dec 9, 2025, Apr 14, 2022 (2 updates tracked since 2022).

About Ethan Matthew Fan NPPES

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

ETHAN MATTHEW FAN (NPI 1649913138) is an individual internal medicine provider in Dallas, Texas, licensed in Texas (W0570) and active in the NPI registry since April 2022. He is enrolled in Medicare PECOS, is affiliated with Texas Health Presbyterian Hospital Kaufman, and is a graduate of Other (2022).

NPPES Registry Identity

NPI1649913138
Entity TypeIndividualMale
Primary Taxonomy207R00000X
Provider Legal NameETHAN MATTHEW FAN
Location Address8200 WALNUT HILL LNDallas, TX 75231-4402
Mailing Address1140 Peacock BlvdCarrollton, TX 75007-2943 · (469) 471-4848
Phone(214) 345-6176
Fax(214) 345-5167
Sole ProprietorNo
Medical School CMSOtherGraduated 2022
Enumeration DateApril 14, 2022
Last NPPES UpdateDecember 9, 20252 updates tracked since enumeration
NPPES CertifiedDecember 9, 2025
✔ NPI 1649913138 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in TX · W0570
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
8200 WALNUT HILL LN, Dallas, TX 75231
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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

Ethan Matthew Fan 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 ID1254826936
PECOS Enrollment IDI20251219001724
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.

Texas Health Presbyterian Hospital Kaufman

Acute Care Hospitals · Kaufman, TX
OwnershipVoluntary non-profit - Private
CMS Certification Number450292
Location850 Ed HallKaufman, TX 75142 · Kaufman County
Emergency services

Texas Health Presbyterian Hospital Dallas

Acute Care Hospitals · Dallas, TX
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number450462
Location8200 Walnut Hill LaneDallas, TX 75231 · Dallas County
Emergency services Birthing friendly

Texas Health Presbyterian Hospital Rockwall

Acute Care Hospitals · Rockwall, TX
5/5 CMS rating
OwnershipProprietary
CMS Certification Number670044
Location3150 Horizon RoadRockwall, TX 75032 · Rockwall County
Emergency services

Texas Health Presbyterian Hospital Flower Mound

Acute Care Hospitals · Flower Mound, TX
5/5 CMS rating
OwnershipProprietary
CMS Certification Number670068
Location4400 Long Prairie RoadFlower Mound, TX 75028 · Denton County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 75231 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
$131.01 typical visit price
range $57.18 – $172.86
Typical copayment $32.75 (range $14.29 – $43.21)
Most-billed visit code 99204
Established Patient
$100.80 typical visit price
range $18.48 – $141.20
Typical copayment $25.20 (range $4.62 – $35.30)
Most-billed visit code 99214
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 20

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

MUPPIDI REHAB, PLLC
Physical Medicine & Rehabilitation
8200 WALNUT HILL LN
DALLAS, TX 75231
Dallas County (214) 345-6789
DR. JOYZELLE HEROD MCCREARY PH.D.
Psychologist (Clinical)
8200 WALNUT HILL LN, DEPARTMENT OF PSYCHIATRY
DALLAS, TX 75231
Dallas County (214) 345-7355
DR. TIMOTHY A. MOORE M.D.
Anesthesiology
8200 WALNUT HILL LN
DALLAS, TX 75231
Dallas County (214) 345-6148
LISA-ANN WUERMSER MD
Physical Medicine & Rehabilitation
8200 WALNUT HILL LN
DALLAS, TX 75231
Dallas County (763) 520-0453
DARREN IMPHEAN MD
Student in an Organized Health Care Education/Training Program
8200 WALNUT HILL LN
DALLAS, TX 75231
Dallas County (214) 345-6789
MRS. MEREDITH DOERRIES RATLIFF
Dietitian, Registered
8200 WALNUT HILL LN
DALLAS, TX 75231
Dallas County (214) 345-7413
DR. ZAID SHAH DO
Internal Medicine
8200 WALNUT HILL LN
DALLAS, TX 75231
Dallas County (817) 881-3127
DR. URSZULA BARBARA KELLEY M.D.
Psychiatry & Neurology (Psychiatry)
8200 WALNUT HILL LN
DALLAS, TX 75231
Dallas County (214) 345-7355

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 Fan's NPI number?

The NPI number for Ethan Fan is 1649913138. It was assigned to this individual provider in the NPPES registry on April 14, 2022.

Where is Ethan Fan located?

Ethan Fan practices at 8200 Walnut Hill Ln, Dallas, TX 75231. The listed phone number is (214) 345-6176.

What is Ethan Fan's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Ethan Fan enrolled in Medicare?

Yes. Ethan Fan 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.

Is Ethan Fan affiliated with any hospitals?

According to CMS data, Ethan Fan is affiliated with Texas Health Presbyterian Hospital Kaufman, Texas Health Presbyterian Hospital Dallas, Texas Health Presbyterian Hospital Rockwall and Texas Health Presbyterian Hospital Flower Mound.

When was this NPI record last updated?

The NPPES record for Ethan Fan was last updated on December 9, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.