Individual provider Active NPI

Evan Mikulich, PA-C

  • Physician Assistant
  • Portsmouth, NH
National Provider Identifier
1275258428
Registry record updated Oct 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
333 Borthwick Ave
Portsmouth, NH 03801-7128
Phone
(603) 436-5110
NPI assigned
Oct 10, 2022
Last updated
Oct 10, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NH Primary

Addresses

Primary practice location

333 Borthwick Ave
Portsmouth, NH 03801-7128

Mailing address

333 Borthwick Ave
Portsmouth, NH 03801-7128

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH
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

Enrollment IDStateProvider typePAC IDDetails
I20230131003090 NH Practitioner - Physician Assistant 5496126310 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Appledore Medical Group IncGroup PAC ID 5698666154, 197 clinicians

Practice addresses (Care Compare)

330 Borthwick Ave
Suite 308
Portsmouth, NH 03801-7112
Phone (603) 431-5242

333 Borthwick Ave
Portsmouth, NH 03801-7128

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Appledore Medical Group, Inc CurrentSince Jan 14, 2023 Accepting new patients
Appledore Medical Group, Inc. Past Accepting new patients

Locations

330 Borthwick Ave
Ste 201
Portsmouth, NH 03801
Phone (603) 431-5242

330 Borthwick Ave
Ste 308
Portsmouth, NH 03801
Phone (603) 431-5242

333 Bothwick Ave
Portsmouth, NH 03801
Phone (603) 433-4907

333 Bothwick Ave
Ste 402
Portsmouth, NH 03801
Phone (603) 433-5110

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

Interoperability endpoints

  • Direct secure messaging: evan.mikulich@hca6.eclinicaldirectplus.com

Organizations & group practices 2

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.

Hospital & facility affiliations 1

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": "1665360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665360000000",
    "number": "1275258428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 BORTHWICK AVE",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "038017128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 BORTHWICK AVE",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "038017128",
            "telephone_number": "603-436-5110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIKULICH",
        "first_name": "EVAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-10-10",
        "last_updated": "2022-10-10",
        "certification_date": "2022-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portsmouth, NH

Sources for this page

Verify at the official NPI Registry.