Individual provider Active NPI

Robert James Evans, APRN

  • Nurse Practitioner
  • Boston, MA
National Provider Identifier
1043984586
Registry record updated Apr 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN210429 Issued in MA
Practice address
55 Fruit St
Boston, MA 02114-2621
Phone
(617) 724-4500
NPI assigned
Aug 8, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN210429 MA Primary
Acute Care Nurse Practitioner 363LA2100X 088716-23 NH

Addresses

Primary practice location

55 Fruit St
Boston, MA 02114-2621

Mailing address

789 Central Ave
Dover, NH 03820-2526
Phone (603) 609-6925

Other practice location 1

789 Central Ave
Dover, NH 03820-2526
Phone (603) 609-6925

Other identifiers 1

IdentifierTypeStateIssuer
3138060MedicaidNH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH
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

Enrollment IDStateProvider typePAC IDDetails
I20221125000103 NH Practitioner - Nurse Practitioner 3870982697 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Intensive Care Consortium IncGroup PAC ID 0244269413, 485 clinicians
Wentworth Douglass Physician CorporationGroup PAC ID 5496749848, 429 clinicians

Practice addresses (Care Compare)

100 McGregor St
Manchester, NH 03102-3730
Phone (603) 668-3545

789 Central Ave
Dover, NH 03820-2526
Phone (603) 609-6260

Hospital & facility affiliations

  • Wentworth-Douglass Hospital Hospital, Dover, NH, CCN 300018

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN210429MAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Intensive Care Consortium Inc Nurse Practitioner CurrentSince Feb 18, 2025 Accepting new patients
Catholic Medical Center CurrentSince Feb 15, 2024 Accepting new patients
Catholic Medical Center CurrentSince Feb 15, 2024 Accepting new patients
Wentworth Douglass Physician Corporation Current Accepting new patients
Wentworth Douglass Physician Corporation CurrentSince Nov 7, 2022 Accepting new patients
Wentworth Douglass Physician Corporation CurrentSince Nov 7, 2022 Accepting new patients
Wentworth Douglass Hospital Current Accepting new patients

Locations

789 Central Ave
#2
Dover, NH 03820
Phone (603) 740-2503

789 Central Ave
#1
Dover, NH 03820
Phone (603) 609-6260

789 Central Ave
Dover, NH 03820
Phone (603) 740-2832

100 McGregor St
Manchester, NH 03102
Phone (603) 663-6931

333 Bothwick Ave
Portsmouth, NH 03801
Phone (603) 433-4907

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

Interoperability endpoints

  • Direct secure messaging: evans.robert.wdh@direct.partners.masshiway.net

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1628380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714348800000",
    "number": "1043984586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "789 CENTRAL AVE",
            "city": "DOVER",
            "state": "NH",
            "postal_code": "038202526",
            "telephone_number": "603-609-6925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142621",
            "telephone_number": "617-724-4500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "789 Central Ave",
            "address_purpose": "LOCATION",
            "city": "Dover",
            "state": "NH",
            "postal_code": "038202526",
            "country_code": "US",
            "telephone_number": "603-609-6925",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EVANS",
        "first_name": "ROBERT",
        "middle_name": "JAMES",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-08",
        "last_updated": "2024-04-29",
        "certification_date": "2023-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MA",
            "license": "RN210429",
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NH",
            "license": "088716-23",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3138060",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.