Evan Randall Schmidt, DDS,MSD

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

12012798A Issued in IN

Practice address

3110 Willowcreek Rd
Portage, IN 46368-4424

Phone

(219) 477-0089

NPI assigned

May 27, 2019

Last updated

May 27, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1558915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558915200000",
    "number": "1275190183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3110 WILLOWCREEK RD",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463684424",
            "telephone_number": "219-477-0089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3110 WILLOWCREEK RD",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463684424",
            "telephone_number": "219-477-0089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHMIDT",
        "first_name": "EVAN",
        "middle_name": "RANDALL",
        "name_prefix": "Dr.",
        "credential": "DDS,MSD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-27",
        "last_updated": "2019-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IN",
            "license": "12012798A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ORTHODONTICS",
            "identifier": "1223X0400X",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIANA DENTAL LICENSE",
            "identifier": "12012798A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVERS LICENSE NUMBER",
            "identifier": "1420-51-3376",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.orthodonticalliances.com",
            "affiliation": "N",
            "endpointDescription": "WebPage",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Valparaiso",
            "address_1": "3110 Willowcreek Rd",
            "city": "Portage",
            "state": "IN",
            "country_code": "US",
            "postal_code": "463684424",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sarver Family Dental
• Jerome Winn Sarver, D.D.S.
• Pamela Calica Saylor
• Cathy A Schadowsky, COTA
• Karen C. Schimpf, M.A.
• Holly Anderson Schmidt, MS CCC-SLP
• Sandra Elaine Scholebo, RN, MSN, FNP
• Teresa Scholebo
• Jeanne B Schramm, NP
• Sarina Schreiber

• Orthodontics and Dentofacial Orthopedics Dentistry in Portage, IN
• Providers in Portage, IN by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2019; 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.