Mr Ethan Edward Smith, PA-C - Medicare Physician Assistant in Spooner, WI

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Mr Ethan Edward Smith, PA-C is a medicare enrolled "Physician Assistant" in Spooner, Wisconsin. He graduated from nursing school in 2024 and has 2 years of diverse experience with area of expertise as Physician Assistant. He is a member of the group practice Advantage Physical Therapy And Sports Rehab, Llc, St Marys Hospital Of Superior and his current practice location is 1180 Chandler Dr, Spooner, Wisconsin. You can reach out to his office (for appointments etc.) via phone at (715) 635-2151.

Mr Ethan Edward Smith is licensed to practice in Wisconsin (license number 8040) 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 1073215984.

Contact Information

Mr Ethan Edward Smith, PA-C
1180 Chandler Dr,
Spooner, WI 54801-2204
(715) 635-2151
Not Available

Map and Direction




Provider's Profile

Full NameMr Ethan Edward Smith
GenderMale
SpecialityPhysician Assistant
Experience2 Years
Location1180 Chandler Dr, Spooner, Wisconsin
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 Ethan Edward Smith graduated from nursing school in 2024
  NPI Data:
  • NPI Number: 1073215984
  • Provider Enumeration Date: 03/22/2023
  • Last Update Date: 09/11/2024
  Medicare PECOS Information:
  • PECOS PAC ID: 3375084783
  • Enrollment ID: I20240925000347

Medical Identifiers

Medical identifiers for Mr Ethan Edward Smith such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1073215984NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363A00000XPhysician Assistant 8040 (Wisconsin)Primary

Medical Facilities Affiliation

Facility NameLocationFacility Type
Essentia Health St Mary's Hospital - SuperiorSuperior, WIHospital
Spooner Health SystemSpooner, WIHospital
Tamarack Health Hayward Medical CenterHayward, WIHospital

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Advantage Physical Therapy And Sports Rehab, Llc8022016336289
St Marys Hospital Of Superior862896422896

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 Ethan Edward Smith allows following entities to bill medicare on his behalf.
Entity NameSt Marys Hospital of Superior
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1083657886
PECOS PAC ID: 8628964228
Enrollment ID: O20040309000070
Entity NameMedical Services, Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1912992827
PECOS PAC ID: 9436061363
Enrollment ID: O20040914001088
Entity NameMedical Services, Inc
Entity TypePart A Provider - Critical Access Hospital
Entity IdentifiersNPI Number: 1912992827
PECOS PAC ID: 9436061363
Enrollment ID: O20061104000208

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 Ethan Edward Smith 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 Ethan Edward Smith, PA-C
400 E 3rd St,
Duluth, MN 55805-1951

Ph: (218) 786-8364		Mr Ethan Edward Smith, PA-C
1180 Chandler Dr,
Spooner, WI 54801-2204

Ph: (715) 635-2151

Reviews and Comments


Physician Assistant Nurses in Spooner, WI

Robert Peterson, PA-C
Physician Assistant
Medicare: Not Enrolled in Medicare
Practice Location: 707 Ash Street, Spooner, WI 54801
Phone: 715-635-2151    

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.