Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ethan T Shaver, PA

Individual provider Physician Assistant · NPI 1013452002

Ethan T Shaver, PA is a Physician Assistant in Green Bay, Wisconsin. Qualified in 2016, 10 years ago. Practices with Baycare Clinic LLP, a 196-clinician group and accepts Medicare assignment. Licensed in Wisconsin.

Years since qualifying
10
Licensed in
WI
In the registry since
2016
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1110 Kepler Dr
Green Bay, WI 54311-8306
Phone: (920) 288-5555
Fax: (920) 288-5550
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X (WI)

Record details

NPI number1013452002
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedDecember 29, 2016
Last updated in NPPESMay 19, 2026
Certification dateMay 19, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Group practice Baycare Clinic Llp — 196 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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