Individual provider Active NPI

Evan Stoler, PA

  • Physician Assistant
  • Cranston, RI
National Provider Identifier
1053909895
Registry record updated Jul 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA01584 Issued in RI
Practice address
1150 Reservoir Ave Ste 203
Cranston, RI 02920-6032
Phone
(401) 259-0340
Fax
(401) 213-8538
NPI assigned
Jan 7, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 12, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X PA01584 RI
Physician Assistant 363A00000X 1167869 NE
Physician Assistant 363A00000X PA01584 RI Primary

Addresses

Primary practice location

1150 Reservoir Ave Ste 203
Cranston, RI 02920-6032

Mailing address

1301 Richmond Ave
Houston, TX 77006-5451

Other practice location 1

2002 Holcombe Blvd
Houston, TX 77030-4211
Phone (713) 791-1414

Other practice location 2

1314 Concord Rd SE
Smyrna, GA 30080-4361
Phone (770) 438-1799

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
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
I20231107000109 RI Practitioner - Physician Assistant 2365822848 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Rhode Island Counseling Associates LLCGroup PAC ID 7618219544, 42 clinicians

Practice addresses (Care Compare)

1150 Reservoir Ave
Suite 203
Cranston, RI 02920-6043
Phone (401) 259-0340

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1167869NEMDPhysician Assistant
PA01584RIMDPhysician Assistant

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1609977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720742400000",
    "number": "1053909895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 RICHMOND AVE",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770065451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 RESERVOIR AVE STE 203",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029206032",
            "telephone_number": "401-259-0340",
            "fax_number": "401-213-8538"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2002 Holcombe Blvd",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770304211",
            "country_code": "US",
            "telephone_number": "713-791-1414",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1314 Concord Rd SE",
            "address_purpose": "LOCATION",
            "city": "Smyrna",
            "state": "GA",
            "postal_code": "300804361",
            "country_code": "US",
            "telephone_number": "770-438-1799",
            "fax_number": "770-825-9046",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STOLER",
        "first_name": "EVAN",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-01-07",
        "last_updated": "2024-07-12",
        "certification_date": "2024-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "RI",
            "license": "PA01584",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "1167869",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "RI",
            "license": "PA01584",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cranston, RI

Sources for this page

Verify at the official NPI Registry.