Active NPI
Evan Loomis, PA-C
- Physician Assistant
- Wailuku, HI
National Provider Identifier
1265711550
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- AMD-523
- Practice address
- 2180 Main St
Wailuku, HI 96793-1625 - Phone
- (808) 242-6464
- Fax
- (808) 424-4209
- NPI assigned
- Aug 4, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 2143 | AK | |
| Physician Assistant | 363A00000X | AMD-523 | HI | Primary |
Addresses
Primary practice location
2180 Main St
Wailuku, HI 96793-1625
Mailing address
2180 Main St
Wailuku, HI 96793-1625
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AMD-523 | HI | MD | Physician Assistant |
| 2143 | AK | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1312416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374537600000",
"number": "1265711550",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2180 MAIN ST",
"city": "WAILUKU",
"state": "HI",
"postal_code": "967931625"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2180 MAIN ST",
"city": "WAILUKU",
"state": "HI",
"postal_code": "967931625",
"telephone_number": "808-242-6464",
"fax_number": "808-424-4209"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOOMIS",
"first_name": "EVAN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-08-04",
"last_updated": "2013-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "AK",
"license": "2143",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "HI",
"license": "AMD-523",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wailuku, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 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.