Evan Keller Martin, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

50.001611 Issued in OH

Practice address

1037 Conneaut Ave
Suite 201
Bowling Green, OH 43402-5301

Phone

(419) 373-6046

Fax

(419) 352-9048

NPI assigned

Feb 27, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Dillon Dermatology LLC

  • Dermatology Physician
  • Bowling Green, OH
  • NPI 1538337480
  NPD (past)

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

{
    "created_epoch": "1361923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361923200000",
    "number": "1134469265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1037 CONNEAUT AVE",
            "address_2": "SUITE 201",
            "city": "BOWLING GREEN",
            "state": "OH",
            "postal_code": "434025301",
            "telephone_number": "419-373-6046",
            "fax_number": "419-352-9048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1037 CONNEAUT AVE",
            "address_2": "SUITE 201",
            "city": "BOWLING GREEN",
            "state": "OH",
            "postal_code": "434025301",
            "telephone_number": "419-373-6046",
            "fax_number": "419-352-9048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "EVAN",
        "middle_name": "KELLER",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-02-27",
        "last_updated": "2013-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.001611",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sharena Meta Mallett
• Katherine Mangold, LSW
• Katherine Meyer Manley
• Natalia V Markelova, MD
• Delayna Martin
• Kevin A Martin, M.D.
• Nancy J Martin, C.N.P.
• Alyssa Martinez-Baker, APRN-CNP
• Daniel Martinez
• Marissa Martinez

• Physician Assistant in Bowling Green, OH
• Providers in Bowling Green, OH by specialty
• Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.