Ethan Waranch, PSYD in Portland, OR - Medicare Psychologist Provider

Ethan Waranch, PSYD is a medicare enrolled "Psychologist" provider in Portland, Oregon. His current practice location is 12636 Se Stark St Bldg J, Portland, Oregon. You can reach out to his office (for appointments etc.) via phone at (503) 253-4600.

Ethan Waranch is licensed to practice in Oregon (license number 3654) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1053764886.

Contact Information

	Ethan Waranch, PSYD
	12636 Se Stark St Bldg J, Portland, OR 97233-1058
	(503) 253-4600
	(503) 253-4605

Map and Direction

Healthcare Provider's Profile

Full Name	Ethan Waranch
Gender	Male
Speciality	Psychologist
Location	12636 Se Stark St Bldg J, Portland, Oregon
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1053764886
Provider Enumeration Date: 07/16/2016
Last Update Date: 02/02/2023

Medicare PECOS Information:

PECOS PAC ID: 2961861273
Enrollment ID: I20230705002505

Medical Identifiers

Medical identifiers for Ethan Waranch such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1053764886	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
103T00000X	Psychologist	3654 (Oregon)	Primary

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. Ethan Waranch allows following entities to bill medicare on his behalf.

Entity Name	Western Psychological And Counseling Services Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1912008178 PECOS PAC ID: 7719975085 Enrollment ID: O20040505000049

Entity Name	Psychological Services Connection Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1275260465 PECOS PAC ID: 7416317789 Enrollment ID: O20230718002835

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. Ethan Waranch 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 Address	Practice Location Address
Ethan Waranch, PSYD 1411 Sw Morrison St, Suite 310, Portland, OR 97205-1945 Ph: (503) 352-2400	Ethan Waranch, PSYD 12636 Se Stark St Bldg J, Portland, OR 97233-1058 Ph: (503) 253-4600

Reviews and Comments

Psychologist in Portland, OR

Dr. Douglas L Dunlap, PH.D. Psychologist Medicare: Medicare Enrolled Practice Location: 1121 Ne 2nd Ave, Portland, OR 97232 Phone: 503-731-8692
Dr. David Hugh Haven, PSYD Psychologist Medicare: Not Enrolled in Medicare Practice Location: 1525 Ne Weidler St Ste 201, Portland, OR 97232 Phone: 503-312-0281
Dr. Susan Orchard, PSY.D. Psychologist Medicare: Not Enrolled in Medicare Practice Location: 7415 N Oatman Ave, Portland, OR 97217 Phone: 503-358-6479
Mrs. Nellie Cichon, CADC 1 Psychologist Medicare: Not Enrolled in Medicare Practice Location: 8202 N Denver Ave, Portland, OR 97217 Phone: 503-285-3200 Fax: 503-245-6263
Alison D. Armour, PSYD Psychologist Medicare: Medicare Enrolled Practice Location: 3550 N Interstate Ave, Portland, OR 97227 Phone: 503-813-2000
Laura Isabel Miranda Olivera, MA, PSYD Psychologist Medicare: Not Enrolled in Medicare Practice Location: 7800 Sw Barbur Blvd Bldg 2, Portland, OR 97219 Phone: 855-295-3276 Fax: 888-588-2752
Dr. Amy W Wagner, PH.D. Psychologist Medicare: Not Enrolled in Medicare Practice Location: 3710 Sw Us Veterans Hospital Rd, V3-satp, Portland, OR 97239 Phone: 503-220-8262 Fax: 360-737-1419

Ethan Waranch, PSYD - Medicare Psychologist in Portland, OR