Mr David J Etzel, CNP - Medicare Nurse Practitioner in Shelby, OH

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Mr David J Etzel, CNP is a medicare enrolled "Nurse Practitioner - Family" in Shelby, Ohio. He graduated from nursing school in 2010 and has 16 years of diverse experience with area of expertise as Nurse Practitioner. He is a member of the group practice Third Street Community Clinic, Inc. and his current practice location is 31 E Main St, Shelby, Ohio. You can reach out to his office (for appointments etc.) via phone at (419) 525-6795.

Mr David J Etzel is licensed to practice in Ohio (license number NP12090) and he also participates in the medicare program. He accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1881999555.

Contact Information

Mr David J Etzel, CNP
31 E Main St,
Shelby, OH 44875-1262
(419) 525-6795
(419) 525-6723

Map and Direction




Provider's Profile

Full NameMr David J Etzel
GenderMale
SpecialityNurse Practitioner
Experience16 Years
Location31 E Main St, Shelby, Ohio
Accepts Medicare AssignmentsYes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Mr David J Etzel graduated from nursing school in 2010
  NPI Data:
  • NPI Number: 1881999555
  • Provider Enumeration Date: 01/11/2011
  • Last Update Date: 05/26/2021
  Medicare PECOS Information:
  • PECOS PAC ID: 0648439315
  • Enrollment ID: I20120315000669

Medical Identifiers

Medical identifiers for Mr David J Etzel such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1881999555NPI-NPPES
12090-NPOtherOHSTATE LICENSE
3110449MedicaidOH

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363L00000XNurse Practitioner 12090-NP (Ohio)Secondary
363LC1500XNurse Practitioner - Community Health 12090-NP (Ohio)Secondary
363LF0000XNurse Practitioner - Family NP12090 (Ohio)Primary

Medical Facilities Affiliation

Facility NameLocationFacility Type
Ohiohealth Mansfield HospitalMansfield, OHHospital
Ohiohealth Shelby HospitalShelby, OHHospital

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Third Street Community Clinic, Inc.236542397723

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. Mr David J Etzel allows following entities to bill medicare on his behalf.
Entity NameThird Street Community Clinic, Inc.
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1649599119
PECOS PAC ID: 2365423977
Enrollment ID: O20040528000770
Entity NameThird Street Community Clinic, Inc.
Entity TypePart B Supplier - Public Health/welfare Agency
Entity IdentifiersNPI Number: 1336252519
PECOS PAC ID: 2365423977
Enrollment ID: O20071009000076
Entity NameThird Street Community Clinic, Inc.
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1720407554
PECOS PAC ID: 2365423977
Enrollment ID: O20141020001750
Entity NameThird Street Community Clinic, Inc.
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1811364706
PECOS PAC ID: 2365423977
Enrollment ID: O20160506000486
Entity NameThird Street Community Clinic, Inc.
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1306499314
PECOS PAC ID: 2365423977
Enrollment ID: O20200420003356
Entity NameThird Street Community Clinic, Inc.
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1629620109
PECOS PAC ID: 2365423977
Enrollment ID: O20200520001554

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. Mr David J Etzel 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 AddressPractice Location Address
Mr David J Etzel, CNP
600 W. Third Street,
Mansfield, OH 44906-2633

Ph: (419) 522-6191		Mr David J Etzel, CNP
31 E Main St,
Shelby, OH 44875-1262

Ph: (419) 525-6795

Reviews and Comments


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Jamie Linn Ladd, NP-C
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Practice Location: 24 E Whitney Ave, Shelby, OH 44875
Phone: 567-247-0872    Fax: 567-247-0873
Monica Gupta, PMHNP-BC
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Phone: 419-564-4667    
Melissa Branham, NP
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Practice Location: 13 South St, Shelby, OH 44875
Phone: 419-709-7766    

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.