Active NPI
Barry Leroy Evans, MASTER SOCIAL WORK
- Clinical Social Worker
- Willmar, MN
National Provider Identifier
1023177201
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 391
- Practice address
- 1125 6TH Street SE
Woodland Centers
Willmar, MN 56201-4675 - Phone
- (320) 231-9148
- Fax
- (320) 231-9140
- NPI assigned
- Dec 6, 2006
- Last updated
- Jul 8, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 391 | MN | Primary |
Addresses
Primary practice location
1125 6TH Street SE
Woodland Centers
Willmar, MN 56201-4675
Mailing address
5285 County Road 4 NE
Atwater, MN 56209
Phone (320) 235-4613
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30024EV | Other | BLUE CROSS | |
| 115671 | Other | UCARE | |
| 1013109 | Other | PREFERRED ONE | |
| 6220225 | Other | UBH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 391 | MN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1023177201",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5285 COUNTY ROAD 4 NE",
"city": "ATWATER",
"state": "MN",
"postal_code": "56209",
"telephone_number": "320-235-4613",
"fax_number": "320-231-9140"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1125 6TH STREET SE",
"address_2": "WOODLAND CENTERS",
"city": "WILLMAR",
"state": "MN",
"postal_code": "562014675",
"telephone_number": "320-231-9148",
"fax_number": "320-231-9140"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANS",
"first_name": "BARRY",
"middle_name": "LEROY",
"name_prefix": "Mr.",
"credential": "MASTER SOCIAL WORK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "391",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "30024EV",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "115671",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "1013109",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UBH",
"identifier": "6220225",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Willmar, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.