NPIMap

Individual provider Active NPI

Chad Evans, PA

  • Physician Assistant
  • Canton, MI
National Provider Identifier
1063961092
Registry record updated Aug 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601009969 Issued in MI
Practice address
43033 Ford Rd
Canton, MI 48187-3375
Phone
(734) 927-5050
NPI assigned
Oct 3, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Practitioner 225400000X
Physician Assistant 363A00000X 5601009969 MI Primary

Addresses

Primary practice location

43033 Ford Rd
Canton, MI 48187-3375

Mailing address

4060 Rochester Rd
Troy, MI 48085-4923

Other practice location 1

3492 Lake Dr SE
Grand Rapids, MI 49546-4338
Phone (616) 957-4057

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200803000342 MI Practitioner - Physician Assistant 3577988989 Reassigns benefits to 13 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pic Indiana PCGroup PAC ID 3476790239, 143 clinicians

Practice addresses (Care Compare)

1131 M 32
Alpena, MI 49707-8222
Phone (989) 250-1925

1803 M
Suite 139
Benton Harbor, MI 49022-6103
Phone (269) 487-3021

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Hometown Urgent Care of Michigan, P.C. CurrentSince Mar 1, 2022 Accepting new patients
Hometown Urgent Care of Michigan, PC CurrentSince Mar 1, 2022 Accepting new patients
Taylor Urgent Care PC CurrentSince Aug 1, 2020 Accepting new patients
Hometown Urgent Care of Michigan, P.C. Current Accepting new patients
Farmington Hills Urgent Care Walk-in Clinic PC PastSince Jul 31, 2022 Accepting new patients
Physicians Immediate Care LTD Past Accepting new patients

Locations

1131 M 32 W
Alpena, MI 49707
Phone (989) 250-1925

25 Columbia Ave E
Battle Creek, MI 49015
Phone (269) 425-3017

1634 Gull Rd
Kalamazoo, MI 49048
Phone (269) 903-2835

23234 Ecorse Rd
Taylor, MI 48180
Phone (313) 292-8400

Organizations & group practices 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1475452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597881600000",
    "number": "1063961092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4060 ROCHESTER RD",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480854923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43033 FORD RD",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481873375",
            "telephone_number": "734-927-5050"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3492 Lake Dr SE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495464338",
            "country_code": "US",
            "telephone_number": "616-957-4057",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EVANS",
        "first_name": "CHAD",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-10-03",
        "last_updated": "2020-08-20",
        "certification_date": "2020-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601009969",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, MI

Sources for this page

Verify at the official NPI Registry.