Evenstar Amelia Forbach, DNP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

240186 Issued in AZ

Practice address

7510 W Bridle TRL
Flagstaff, AZ 86001-8021

Phone

(928) 600-1731

NPI assigned

Jun 21, 2021

Last updated

Jun 21, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Arizona Advanced Surgery LLCGroup PAC ID 0547690166, 93 clinicians

Sandstone Medical Alliance LLCGroup PAC ID 1759852775, 8 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Flagstaff Medical Center Hospital, Flagstaff, AZ, CCN 030023
• Verde Valley Medical Center Hospital, Cottonwood, AZ, CCN 030007

Merit-based Incentive Payment System (MIPS)

Final score

94.9 of 100Reported as group

Promoting interoperability

94

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/IGJBCD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Arizona Advanced Surgery LLC

  • Surgery Physician
  • Phoenix, AZ
  • NPI 1346880838
  Medicare reassignment Care Compare group NPD
• Sandstone Medical Alliance LLC

  • Vascular Surgery Physician
  • Phoenix, AZ
  • NPI 1295621886
  Medicare reassignment Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Flagstaff Medical Center

  dba Guardian Air

  • Air Ambulance
  • Flagstaff, AZ
  • NPI 1427234111

  Hospital

  Care Compare affiliation
• Flagstaff Medical Center

  dba Guardian Medical Transport

  • Land Ambulance
  • Flagstaff, AZ
  • NPI 1518143205

  Hospital

  Care Compare affiliation
• Flagstaff Medical Center

  dba FMC Behavioral Health Services

  • Psychiatric Hospital Unit
  • Flagstaff, AZ
  • NPI 1649370875
  Care Compare affiliation
• Flagstaff Medical Center

  • General Acute Care Hospital
  • Flagstaff, AZ
  • NPI 1780635078
  Care Compare affiliation
• Verde Valley Medical Center

  • General Acute Care Hospital
  • Cottonwood, AZ
  • NPI 1346291648
  Care Compare affiliation
• Verde Valley Medical Center

  dba Northern Arizona Healthcare - Sedona

  • General Acute Care Hospital
  • Sedona, AZ
  • NPI 1538608716
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1624233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624233600000",
    "number": "1033788427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7510 W BRIDLE TRL",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860018021",
            "telephone_number": "928-600-1731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7510 W BRIDLE TRL",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860018021",
            "telephone_number": "928-600-1731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORBACH",
        "first_name": "EVENSTAR",
        "middle_name": "AMELIA",
        "name_prefix": "Dr.",
        "credential": "DNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-21",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AZ",
            "license": "240186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Flugstad, LPC
• Kristen Deanne Flugstad, PSYD
• Lauren Loyal Fofanova, LCSW
• Karlee Nicole Folkesson
• For Your Family, Co.
• Julia Elizabeth Forberg, MD
• Forest Canyon Endoscopy & Surgery Ctr PC
• Forest Canyon Endoscopy &Surgery Ctr PC
• Forest Country Anesthesia, P.C.
• Forkela, LLC (Vuori Health)

• Acute Care Nurse Practitioner in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• Acute Care Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2021; 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.

Verify at the official NPI Registry.