Individual provider Active NPI

Evan Tank, DO

  • Epilepsy Physician
  • Grand Rapids, MI
National Provider Identifier
1124316054
Registry record updated May 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Epilepsy PhysicianTaxonomy code 2084E0001X
License
5101019162 Issued in MI
Practice address
275 Michigan St NE
Grand Rapids, MI 49503-2531
Phone
(616) 267-7900
Fax
(616) 267-7901
NPI assigned
Jul 12, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2026

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X OP70051303 WA
Neurology Physician 2084N0400X 6514 TN
Neurology Physician 2084N0400X 0102207882 VA
Neurology Physician 2084N0400X 5101019162 MI
Epilepsy Physician 2084E0001X 5101019162 MI Primary
Neurology Physician 2084N0400X 02007671A IN

Addresses

Primary practice location

275 Michigan St NE
Grand Rapids, MI 49503-2531

Mailing address

100 Michigan St NE
MC 845
Grand Rapids, MI 49503-2560

Other practice location 1

1901 S Shady St
Mountain City, TN 37683-2021
Phone (423) 727-1103

Other practice location 2

400 N State of Franklin Rd
Johnson City, TN 37604-6035
Phone (423) 431-6111

Other practice location 3

1519 Main St
Sneedville, TN 37869-3657
Phone (423) 733-5070

Other practice location 4

851 Locust St
Rogersville, TN 37857-2407
Phone (423) 921-7000

Other practice location 5

300 Med Tech Pkwy
Johnson City, TN 37604-2277
Phone (423) 302-1000

Other practice location 6

1990 Holton Ave E
Big Stone Gap, VA 24219-3350
Phone (276) 523-3111

Other practice location 7

1 Medical Park Blvd
Bristol, TN 37620-7430
Phone (423) 844-1121

Other practice location 8

58 Carroll St
Lebanon, VA 24266-4510
Phone (276) 883-8000

Other practice location 9

601 John St Ste M-124
Kalamazoo, MI 49007-5377
Phone (269) 341-7500

Other practice location 10

130 W Ravine Rd
Kingsport, TN 37660-3837
Phone (423) 224-4000

Other practice location 11

100 15th St NW
Norton, VA 24273-1616
Phone (276) 439-1000

Other practice location 12

127 Health Care Dr
Pennington Gap, VA 24277-2853
Phone (276) 546-5212

Other practice location 13

245 Medical Park Dr
Marion, VA 24354-1100
Phone (276) 378-1000

Other practice location 14

16000 Johnston Memorial Dr
Abingdon, VA 24211-7664
Phone (276) 258-1000

Other practice location 15

2000 Brookside Dr
Kingsport, TN 37660-4627
Phone (423) 857-7000

Other practice location 16

1250 E Marshall St
Richmond, VA 23298-5023
Phone (804) 828-9350

Other practice location 17

1105 Sixth St
Traverse City, MI 49684-2345
Phone (231) 935-6239

Other practice location 18

2801 N Gantenbein Ave
Portland, OR 97227-1623
Phone (503) 413-2200

Other practice location 19

1501 W Elk Ave
Elizabethton, TN 37643-2874
Phone (423) 542-1300

Other practice location 20

1420 Tusculum Blvd
Greeneville, TN 37745-4279
Phone (423) 787-5000

Other practice location 21

312 Hospital Dr
Clintwood, VA 24228-6786
Phone (276) 926-0300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, VA, IN, NM, WA, OR6 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 6

Enrollment IDStateProvider typePAC IDDetails
I20160623000568 MI Practitioner - Neurology 9931417813 Reassigns benefits to 8 organizations
I20240215001466 VA Practitioner - Neurology 9931417813 Reassigns benefits to 1 organization
I20241014001793 IN Practitioner - Neurology 9931417813 Reassigns benefits to 1 organization
I20250213001806 NM Practitioner - Neurology 9931417813 Reassigns benefits to 1 organization
I20251031004188 WA Practitioner - Psychiatry 9931417813 Reassigns benefits to 1 organization
I20251201002628 OR Practitioner - Psychiatry 9931417813 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Michigan State University College of Osteopathic Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Munson Medical CenterGroup PAC ID 3072426287, 377 clinicians
MCV Associated PhysiciansGroup PAC ID 4385542117, 1,779 clinicians
Bronson Methodist HospitalGroup PAC ID 0244148633, 721 clinicians

Practice addresses (Care Compare)

100 Michigan Ave NE
Grand Rapids, MI 49503-2560

100 Michigan St NE RM
280 Corewell Health Medical Group West
Grand Rapids, MI 49503-2560
Phone (616) 267-0115

1009 W Green St
Corewell Health Medical Group West
Hastings, MI 49058-1710
Phone (269) 945-1212

1105 6TH St
Traverse City, MI 49684-2345
Phone (231) 935-6510

1200 E Marshall St
Richmond, VA 23298-5023
Phone (804) 828-9000

1250 E Marshall St
Richmond, VA 23298-5051

1840 Wealthy St SE
Corewell Health Medical Group West
Grand Rapids, MI 49506-2921
Phone (616) 885-5000

25 Michigan St NE
6100 Corewell Health Medical Group West
Grand Rapids, MI 49503-2561
Phone (616) 267-7900

275 Michigan St NE
Grand Rapids, MI 49503-2531
Phone (616) 267-8700

2801 N Gantenbein Ave
Portland, OR 97227-1623
Phone (503) 413-2042

300 N Ave
Battle Creek, MI 49017-3307
Phone (888) 258-0875

401 N 11TH St
Richmond, VA 23219-1914
Phone (804) 828-8737

4444 Kalamazoo Ave SE
200 Corewell Health Medical Group West
Kentwood, MI 49508-4600
Phone (616) 391-5600

605 Oak St
Big Rapids, MI 49307-2048
Phone (231) 592-4270

8333 Felch St
Zeeland, MI 49464-2608

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
02007671AINMDNeurology Physician
5101019162MIMDNeurology Physician
6514TNMDNeurology Physician
0102207882VAMDNeurology Physician
OP70051303WAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeland Medical Practices CurrentSince Oct 1, 2021 Accepting new patients
Lakeland Community Hospital Watervliet CurrentSince Oct 1, 2021 Accepting new patients
Munson Medical Center Neurology CurrentSince Oct 27, 2022 Accepting new patients
Franciscan Physician Network CurrentSince Apr 10, 2025 Accepting new patients
Pathology Assoc of Southwestern Michigan, PC Current Accepting new patients
Legacy Emanuel Hospital & Health Center CurrentSince Jan 20, 2026 Accepting new patients
Legacy Salmon Creek Hospital CurrentSince Oct 20, 2025 Accepting new patients
Munson Medical Center CurrentSince Oct 27, 2022 Accepting new patients
Bronson Battle Creek Hospital CurrentSince Feb 1, 2021 Accepting new patients
Lakeland Community Hospital Watervliet Current Accepting new patients
MCV Associated Physicians Neurology CurrentSince Dec 10, 2023 Accepting new patients
Spectrum Health Primary Care Partners CurrentSince Aug 15, 2016 Accepting new patients
Lakeland Medical Practices CurrentSince Oct 1, 2021 Accepting new patients
Union Hospital, Inc. CurrentSince Nov 15, 2024 Accepting new patients
Franciscan Physician Network CurrentSince Apr 10, 2025 Accepting new patients
Legacy Emanuel Hospital & Health Center CurrentSince Jan 20, 2026 Accepting new patients
Cibola General Hospital Corporation CurrentSince Feb 1, 2025 Accepting new patients
Bronson Methodist Hospital Neurology CurrentSince Feb 1, 2021 Accepting new patients
Bronson Battle Creek Hospital Neurology CurrentSince Feb 1, 2021 Accepting new patients
Lakeland Hospitals at Niles and St Joseph, Inc CurrentSince Oct 1, 2021 Accepting new patients
Legacy Salmon Creek Hospital CurrentSince Oct 20, 2025 Accepting new patients
Munson Medical Center Current Accepting new patients
Lakeland Hospitals at Niles and St Joseph, Inc CurrentSince Oct 1, 2021 Accepting new patients
Spectrum Health Primary Care Partners CurrentSince Aug 15, 2016 Accepting new patients
Lakeland Community Hospital Watervliet CurrentSince Oct 1, 2021 Accepting new patients
Legacy Clinics LLC CurrentSince Nov 14, 2025 Accepting new patients
Legacy Clinics LLC CurrentSince Nov 14, 2025 Accepting new patients
Metropolitan Hospital Psychiatry CurrentSince Jun 1, 2022 Accepting new patients
Union Hospital, Inc. CurrentSince Nov 15, 2024 Accepting new patients
Metropolitan Hospital Past Accepting new patients
Metropolitan Hospital Past Accepting new patients
Union Hospital Inc Past Accepting new patients
Spectrum Health Hospitals Past Accepting new patients

Locations (25 of 26)

2513 Momentum Pl
Chicago, IL 60689
Phone (231) 935-8031

1704 Lafayette Rd
Ste 4
Crawfordsvlle, IN 47933
Phone (765) 364-3120

1701 S Creasy Ln
Lafayette, IN 47905
Phone (765) 502-4400

150 W Washington St
Shelbyville, IN 46176
Phone (317) 392-3211

1606 N 7th St
Terre Haute, IN 47804
Phone (812) 238-7523

300 North Ave
Fl 2
Battle Creek, MI 49017
Phone (269) 245-5862

300 North Ave
Battle Creek, MI 49017
Phone (269) 966-8000

2750 E Beltline Ave NE
Grand Rapids, MI 49525
Phone (616) 267-7015

275 Michigan St NE
Grand Rapids, MI 49503
Phone (616) 267-7900

25 Michigan St NE
Ste 6100
Grand Rapids, MI 49503
Phone (616) 267-7900

100 Michigan St NE
#845
Grand Rapids, MI 49503
Phone (616) 391-8242

601 John St
Ste M-124
Kalamazoo, MI 49007
Phone (269) 341-7500

4444 Kalamazoo Ave SE
Ste 200
Kentwood, MI 49508
Phone (616) 391-5600

1234 Napier Ave
Saint Joseph, MI 49085
Phone (269) 982-4941

3950 Hollywood Rd
Ste 280
Saint Joseph, MI 49085
Phone (269) 408-0990

1105 Sixth St
Traverse City, MI 49684
Phone (231) 922-9000

400 Medical Park Dr
Watervliet, MI 49098
Phone (269) 463-3111

5900 Byron Center Ave SW
Wyoming, MI 49519
Phone (616) 252-3243

1423 E Roosevelt Ave
Grants, NM 87020
Phone (505) 287-6500

1016 E Roosevelt Ave
Grants, NM 87020
Phone (505) 287-4446

2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200

1015 NW 22nd Ave
Portland, OR 97210
Phone (503) 413-7582

1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134

401 N 11th St
Richmond, VA 23219
Phone (804) 828-4409

1250 E Marshall St
Richmond, VA 23298
Phone (804) 628-6990

Interoperability endpoints

  • Direct secure messaging: etank5332441@direct.casso.us.com
  • Direct secure messaging: etank1309570@ahs.direct-ci.com
  • Direct secure messaging: etank121948@epic00.corewelldirect.org
  • FHIR API: https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/R4/

Organizations & group practices 33

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.

View all 33

Hospital & facility affiliations 10

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": "1310428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778198400000",
    "number": "1124316054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "address_2": "MC 845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 MICHIGAN ST NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032531",
            "telephone_number": "616-267-7900",
            "fax_number": "616-267-7901"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1901 S Shady St",
            "address_purpose": "LOCATION",
            "city": "Mountain City",
            "state": "TN",
            "postal_code": "376832021",
            "country_code": "US",
            "telephone_number": "423-727-1103",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "400 N State of Franklin Rd",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376046035",
            "country_code": "US",
            "telephone_number": "423-431-6111",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1519 Main St",
            "address_purpose": "LOCATION",
            "city": "Sneedville",
            "state": "TN",
            "postal_code": "378693657",
            "country_code": "US",
            "telephone_number": "423-733-5070",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "851 Locust St",
            "address_purpose": "LOCATION",
            "city": "Rogersville",
            "state": "TN",
            "postal_code": "378572407",
            "country_code": "US",
            "telephone_number": "423-921-7000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 Med Tech Pkwy",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376042277",
            "country_code": "US",
            "telephone_number": "423-302-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1990 Holton Ave E",
            "address_purpose": "LOCATION",
            "city": "Big Stone Gap",
            "state": "VA",
            "postal_code": "242193350",
            "country_code": "US",
            "telephone_number": "276-523-3111",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Medical Park Blvd",
            "address_purpose": "LOCATION",
            "city": "Bristol",
            "state": "TN",
            "postal_code": "376207430",
            "country_code": "US",
            "telephone_number": "423-844-1121",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "58 Carroll St",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "VA",
            "postal_code": "242664510",
            "country_code": "US",
            "telephone_number": "276-883-8000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "601 John St Ste M-124",
            "address_purpose": "LOCATION",
            "city": "Kalamazoo",
            "state": "MI",
            "postal_code": "490075377",
            "country_code": "US",
            "telephone_number": "269-341-7500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "130 W Ravine Rd",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376603837",
            "country_code": "US",
            "telephone_number": "423-224-4000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 15th St NW",
            "address_purpose": "LOCATION",
            "city": "Norton",
            "state": "VA",
            "postal_code": "242731616",
            "country_code": "US",
            "telephone_number": "276-439-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "127 Health Care Dr",
            "address_purpose": "LOCATION",
            "city": "Pennington Gap",
            "state": "VA",
            "postal_code": "242772853",
            "country_code": "US",
            "telephone_number": "276-546-5212",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "245 Medical Park Dr",
            "address_purpose": "LOCATION",
            "city": "Marion",
            "state": "VA",
            "postal_code": "243541100",
            "country_code": "US",
            "telephone_number": "276-378-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "16000 Johnston Memorial Dr",
            "address_purpose": "LOCATION",
            "city": "Abingdon",
            "state": "VA",
            "postal_code": "242117664",
            "country_code": "US",
            "telephone_number": "276-258-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2000 Brookside Dr",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376604627",
            "country_code": "US",
            "telephone_number": "423-857-7000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1250 E Marshall St",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "VA",
            "postal_code": "232985023",
            "country_code": "US",
            "telephone_number": "804-828-9350",
            "fax_number": "804-807-7949",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1105 Sixth St",
            "address_purpose": "LOCATION",
            "city": "Traverse City",
            "state": "MI",
            "postal_code": "496842345",
            "country_code": "US",
            "telephone_number": "231-935-6239",
            "fax_number": "231-935-7251",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2801 N Gantenbein Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972271623",
            "country_code": "US",
            "telephone_number": "503-413-2200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1501 W Elk Ave",
            "address_purpose": "LOCATION",
            "city": "Elizabethton",
            "state": "TN",
            "postal_code": "376432874",
            "country_code": "US",
            "telephone_number": "423-542-1300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1420 Tusculum Blvd",
            "address_purpose": "LOCATION",
            "city": "Greeneville",
            "state": "TN",
            "postal_code": "377454279",
            "country_code": "US",
            "telephone_number": "423-787-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "312 Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Clintwood",
            "state": "VA",
            "postal_code": "242286786",
            "country_code": "US",
            "telephone_number": "276-926-0300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TANK",
        "first_name": "EVAN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-12",
        "last_updated": "2026-05-08",
        "certification_date": "2026-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WA",
            "license": "OP70051303",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "TN",
            "license": "6514",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "VA",
            "license": "0102207882",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": "5101019162",
            "primary": false
        },
        {
            "code": "2084E0001X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Epilepsy",
            "state": "MI",
            "license": "5101019162",
            "primary": true
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IN",
            "license": "02007671A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.