NPIMap

Individual provider Active NPI

Kelly Evans, D.O.

  • Internal Medicine Physician
  • Manchester, KY
National Provider Identifier
1124107693
Registry record updated Jan 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
02584 Issued in KY
Practice address
85 Highway 80
Manchester, KY 40962-8801
Phone
(606) 596-0410
Fax
(606) 528-8272
NPI assigned
Nov 3, 2006
Last updated
Jan 17, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 02584 KY Primary

Addresses

Primary practice location

85 Highway 80
Manchester, KY 40962-8801

Mailing address

1019 Cumberland Falls Hwy
Suite B201
Corbin, KY 40701-2735
Phone (606) 526-9005

Other identifiers 1

IdentifierTypeStateIssuer
64012206MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20070822000548 KY Practitioner - Family Practice 9830281880 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Philadelphia College of Osteopathic Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

14662 N US Hwy 25 E
Corbin, KY 40701-6425
Phone (606) 526-9005

313 S Cherry St
Pineville, KY 40977-1724
Phone (606) 654-3338

85 Hwy 80
Manchester, KY 40962-8801
Phone (606) 596-0410

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Grace Community Health Center, Inc. CurrentSince Nov 4, 2013 Accepting new patients
Grace Community Health Center, Inc. Current Accepting new patients
Grace Community Health Center Inc CurrentSince Nov 4, 2013 Accepting new patients
Owsley County Health Care Center, Inc. Past Accepting new patients
Landmark of Laurel Creek Rehabilitation and Nursing Center Past Accepting new patients
Parkway Medical Clinic Past Accepting new patients

Locations

1019 Cumberland Falls Hwy
Ste B201
Corbin, KY 40701

14662 N US Highway 25 E
Corbin, KY 40701
Phone (606) 526-9005

39 Cumberland Gap Plz
Gray, KY 40734
Phone (606) 526-9005

21154 Highway 421
Ste 1
Hyden, KY 41749

272 London Mountain View Dr
London, KY 40741
Phone (606) 231-2614

934 S Laurel Rd
Ste 1
London, KY 40744
Phone (606) 526-8604

85 Highway 80
Manchester, KY 40962
Phone (606) 596-0410

313 S Cherry St
Pineville, KY 40977
Phone (606) 654-3338

Interoperability endpoints

  • Direct secure messaging: kevans704616@direct.ochin.org

Organizations & group practices 6

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 7

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": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547683200000",
    "number": "1124107693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1019 CUMBERLAND FALLS HWY",
            "address_2": "SUITE B201",
            "city": "CORBIN",
            "state": "KY",
            "postal_code": "407012735",
            "telephone_number": "606-526-9005",
            "fax_number": "606-526-8606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 HIGHWAY 80",
            "city": "MANCHESTER",
            "state": "KY",
            "postal_code": "409628801",
            "telephone_number": "606-596-0410",
            "fax_number": "606-528-8272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "KELLY",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-03",
        "last_updated": "2019-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "02584",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64012206",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, KY

Sources for this page

Verify at the official NPI Registry.