Clinton Wilkinson Evans, M.D., D.M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

4563 Issued in AL

Practice address

216 Healthwest Dr
Dothan, AL 36303-1942

Phone

(334) 792-1158

Fax

(334) 702-6983

NPI assigned

Dec 2, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Oral Surgery

Education

University of Alabama School of Dentistry, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southeastern Oral-Maxillofacial and Cosmetic Surgery CenterGroup PAC ID 0042283863, 3 clinicians

Southeastern-Oms, LLCGroup PAC ID 1658859566, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Southeastern Oral-Maxillofacial and Cosmetic Surgery Center

  • Oral and Maxillofacial Surgery (Dentist)
  • Dothan, AL
  • NPI 1275755860
  Medicare reassignment Care Compare group NPD
• Southeastern-Oms, LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Dothan, AL
  • NPI 1609615871
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1133481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347926400000",
    "number": "1093799009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 HAMPTON WAY",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363056319",
            "telephone_number": "334-792-1158",
            "fax_number": "334-702-6983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 HEALTHWEST DR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363031942",
            "telephone_number": "334-792-1158",
            "fax_number": "334-702-6983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "CLINTON",
        "middle_name": "WILKINSON",
        "name_prefix": "Dr.",
        "credential": "M.D., D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-02",
        "last_updated": "2012-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AL",
            "license": "22785",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AL",
            "license": "4563",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000095652",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSAL ENTERPRISE OFFICE",
            "identifier": "51097740",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSAL DOTHAN OFFICE",
            "identifier": "51095652",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "766464",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mason Estes
• Kara Etheredge, MA, BCBA
• Kristyn Rouse Etheredge, LPC
• Leslie Ann Ethridge, CRNP, FNP
• James Anthony Eubanks Jr., MSPT, OCS
• David H Evans, MD
• John Evans Jr., NURSE PRACTITIONER
• Extended Care Medical Associates LLC
• Extendicare, Inc
• Eye Care Associates of the Southeast, P.C.

• Oral and Maxillofacial Surgery (Dentist) in Dothan, AL
• Providers in Dothan, AL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2012; 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.