NPIMap

Individual provider Active NPI

John C Evanoff Jr., MD

  • Family Medicine Physician
  • Metamora, OH
National Provider Identifier
1093714503
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35059829 Issued in OH
Practice address
1990 Country Rd U
Metamora, OH 43540
Phone
(419) 644-4818
Fax
(419) 644-2589
NPI assigned
Jul 18, 2005
Last updated
Nov 3, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35059829 OH Primary

Addresses

Primary practice location

1990 Country Rd U
Metamora, OH 43540

Mailing address

1990 Country Rd U
Metamora, OH 43540
Phone (419) 644-4818

Other identifiers 6

IdentifierTypeStateIssuer
000000141243OtherOHANTHEM
02035OtherOHPARAMOUNT
080120479OtherOHRRMC
0635152OtherOHAETNA
01-03360OtherOHUHC
0791586MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jevanoff7612@epicdirect.promedica.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20100706000119 OH Practitioner - Family Practice 7618026386 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Promedica Central PhysiciansGroup PAC ID 2365348190, 785 clinicians

Practice addresses (Care Compare)

1990 County Rd U
Metamora, OH 43540-9717
Phone (419) 644-4818

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35059829OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Promedica Central Physicians Family Medicine CurrentSince Apr 1, 1999 Accepting new patients
Promedica Central Physicians CurrentSince Apr 1, 1999 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

1990 County Road U
Metamora, OH 43540
Phone (419) 644-4818

100 Madison Ave
Toledo, OH 43604
Phone (567) 585-1964

2109 Hughes Dr
Ste 450
Toledo, OH 43606
Phone (419) 251-3112

Interoperability endpoints

  • Direct secure messaging: jevanoff7612@direct.promedica.org
  • Direct secure messaging: jevanoff7612@epicdirect.promedica.org

Organizations & group practices 3

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.

Hospital & facility affiliations 8

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": "1121644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1093714503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1990 COUNTRY RD U",
            "city": "METAMORA",
            "state": "OH",
            "postal_code": "43540",
            "telephone_number": "419-644-4818",
            "fax_number": "419-644-2589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1990 COUNTRY RD U",
            "city": "METAMORA",
            "state": "OH",
            "postal_code": "43540",
            "telephone_number": "419-644-4818",
            "fax_number": "419-644-2589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANOFF",
        "first_name": "JOHN",
        "middle_name": "C",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-18",
        "last_updated": "2023-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35059829",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000141243",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARAMOUNT",
            "identifier": "02035",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMC",
            "identifier": "080120479",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0635152",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "01-03360",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0791586",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jevanoff7612@epicdirect.promedica.org",
            "affiliation": "N",
            "address_1": "100 Madison Ave",
            "city": "Toledo",
            "state": "OH",
            "country_code": "US",
            "postal_code": "436041516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Metamora, OH

Sources for this page

Verify at the official NPI Registry.