Active NPI
Evan David Evans, PA-C
- Physician Assistant
- Phoenix, AZ
National Provider Identifier
1013548056
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9014
- Practice address
- 1313 E Osborn Rd Ste 150
Phoenix, AZ 85014-5688 - Phone
- (602) 222-1900
- Fax
- (602) 266-3870
- NPI assigned
- Jan 29, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | |||
| Physician Assistant | 363A00000X | PA9014 | MA | Primary |
Addresses
Primary practice location
1313 E Osborn Rd Ste 150
Phoenix, AZ 85014-5688
Mailing address
77 E Thomas Rd Ste 230
Phoenix, AZ 85012-3100
Phone (602) 222-1900
Other practice location 1
501 Gopher Dr
Tomah, WI 54660-4513
Phone (608) 372-2181
Other practice location 2
Corner of Routes N12 & N7
Fort Defiance, AZ 86504
Phone (928) 729-8000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY, MA, TN, GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 4
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2525 Desales Ave
Chattanooga, TN 37404-1161
Phone (423) 495-4430
4710 Battlefield Pkwy
Ringgold, GA 30736-5164
Phone (423) 826-8220
Hospital & facility affiliations
- Memorial Healthcare System, Inc
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5954 | TN | MD | Speech-Language Pathologist |
| PA9014 | MA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Good Samaritan Hospital Medical | Current | Accepting new patients | |
| Diagnostic Imaging Consultants Inc | Current | Accepting new patients |
Locations
100 Gross Crescent Cir
Ft Oglethorpe, GA 30742
Phone (706) 858-2301
1000 Montauk Hwy
West Islip, NY 11795
Phone (516) 705-2689
2525 Desales Ave
Chattanooga, TN 37404
Phone (423) 495-2620
Organizations & group practices 7
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Emergency Medicine Physician
- Worcester, MA
- NPI 1730885252
-
- Physician Assistant
- West Islip, NY
- NPI 1518901180
-
- Emergency Medicine Physician
- Uniondale, NY
- NPI 1588098172
-
- Emergency Medicine Physician
- West Islip, NY
- NPI 1104978014
-
- Specialist
- Bethpage, NY
- NPI 1881799153
-
- Critical Care Medicine (Internal Medicine) Physician
- West Islip, NY
- NPI 1548501620
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Hixson, TN
- NPI 1083778633
-
- General Acute Care Hospital
- Chattanooga, TN
- NPI 1255428736
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1580256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689552000000",
"number": "1013548056",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "77 E THOMAS RD STE 230",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850123100",
"telephone_number": "602-222-1900",
"fax_number": "602-557-0002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1313 E OSBORN RD STE 150",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850145688",
"telephone_number": "602-222-1900",
"fax_number": "602-266-3870"
}
],
"practiceLocations": [
{
"address_1": "501 Gopher Dr",
"address_purpose": "LOCATION",
"city": "Tomah",
"state": "WI",
"postal_code": "546604513",
"country_code": "US",
"telephone_number": "608-372-2181",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "Corner of Routes N12 & N7",
"address_purpose": "LOCATION",
"city": "Fort Defiance",
"state": "AZ",
"postal_code": "86504",
"country_code": "US",
"telephone_number": "928-729-8000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "EVANS",
"first_name": "EVAN",
"middle_name": "DAVID",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-01-29",
"last_updated": "2023-07-17",
"certification_date": "2023-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MA",
"license": "PA9014",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.