Matthew Shane Evans, CPO

Primary specialty

ProsthetistTaxonomy code 224P00000X

License

CPO02042 Issued in CA

Practice address

1705 Coffee Rd
Suite 1
Modesto, CA 95355-2809

Phone

(209) 544-2273

Fax

(209) 544-2274

NPI assigned

Dec 16, 2008

Last updated

May 22, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• San Joaquin Orthotics & Prosthetics

  • Prosthetic/Orthotic Supplier
  • Stockton, CA
  • NPI 1649290107

  Orthotist

  NPD Authorized official

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

{
    "created_epoch": "1229385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400716800000",
    "number": "1245476597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 COFFEE RD",
            "address_2": "SUITE1",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953552809",
            "telephone_number": "209-544-2273",
            "fax_number": "209-544-2274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 COFFEE RD",
            "address_2": "SUITE 1",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953552809",
            "telephone_number": "209-544-2273",
            "fax_number": "209-544-2274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "MATTHEW",
        "middle_name": "SHANE",
        "credential": "CPO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-12-16",
        "last_updated": "2014-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "CA",
            "license": "CPO02042",
            "primary": false
        },
        {
            "code": "222Z00000X",
            "taxonomy_group": "",
            "desc": "Orthotist",
            "state": "CA",
            "license": "CPO02042",
            "primary": false
        },
        {
            "code": "224P00000X",
            "taxonomy_group": "",
            "desc": "Prosthetist",
            "state": "CA",
            "license": "CPO02042",
            "primary": true
        },
        {
            "code": "224L00000X",
            "taxonomy_group": "",
            "desc": "Pedorthist",
            "state": "CA",
            "license": "CPO02042",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "XC0020420",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alyssa Evans
• Cali Evans
• Deven Evans
• Heather Lorraine Evans, RN, PHN
• Kinnesha Evans, B.A.
• Rebecca Evans, RN, BSN, PHN
• Kathleen Lynn Eve, MD
• Jamie Everett, BA
• Evergreen Convalescent Hospital and Rehabilitation Center, Inc. (Evergreen Nursing & Rehabilitation Care Center)
• Jahnae Everhart

• Prosthetist in Modesto, CA
• Providers in Modesto, CA by specialty
• Prosthetist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 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.

Verify at the official NPI Registry.