Active NPI
Rexford W Evans, PA
- Physician Assistant
- Canton, NY
National Provider Identifier
1093802621
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 002857-1
- Practice address
- 80 E Main St
Canton, NY 13617-1450 - Phone
- (315) 386-3300
- Fax
- (315) 261-6330
- NPI assigned
- Oct 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 002857-1 | NY | Primary |
Addresses
Primary practice location
80 E Main St
Canton, NY 13617-1450
Mailing address
50 Leroy St
Potsdam, NY 13676-1786
Phone (315) 261-5505
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002857-1 | Other | NY | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002857-1 | NY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1093802621",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50 LEROY ST",
"city": "POTSDAM",
"state": "NY",
"postal_code": "136761786",
"telephone_number": "315-261-5505",
"fax_number": "315-261-6400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "80 E MAIN ST",
"city": "CANTON",
"state": "NY",
"postal_code": "136171450",
"telephone_number": "315-386-3300",
"fax_number": "315-261-6330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANS",
"first_name": "REXFORD",
"middle_name": "W",
"name_prefix": "Mr.",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "002857-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "002857-1",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Canton, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.