Active NPI
Carlotta Ann Evans, D.D.S.
- Orthodontics and Dentofacial Orthopedics Dentistry
- Chicago, IL
National Provider Identifier
1124018841
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 021-001786
- Practice address
- 801 S Paulina St
MC 841
Chicago, IL 60612-7210 - Phone
- (312) 996-7138
- Fax
- (312) 996-0873
- NPI assigned
- Oct 25, 2005
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 021-001786 | IL | Primary |
Addresses
Primary practice location
801 S Paulina St
MC 841
Chicago, IL 60612-7210
Mailing address
801 S Paulina St
MC 841
Chicago, IL 60612-7210
Phone (312) 996-7138
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A2741KD1 | Medicaid | IL |
Other names 1
- Dr. Carla Ann Evans
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021-001786 | IL | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Board of Trustees of the University of Illinois | Orthodontics and Dentofacial Orthopedics | Past | Accepting new patients |
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.
-
- Dentist
- Chicago, IL
- NPI 1992873921
Orthodontics and Dentofacial Orthopedics
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130198400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410220800000",
"number": "1124018841",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "801 S PAULINA ST",
"address_2": "MC 841",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606127210",
"telephone_number": "312-996-7138",
"fax_number": "312-996-0873"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 S PAULINA ST",
"address_2": "MC 841",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606127210",
"telephone_number": "312-996-7138",
"fax_number": "312-996-0873"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANS",
"first_name": "CARLOTTA",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-10-25",
"last_updated": "2014-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "IL",
"license": "021-001786",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "A2741KD1",
"state": "IL"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "CARLA",
"last_name": "EVANS",
"middle_name": "ANN",
"prefix": "DR.",
"credential": "D.D.S.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.