Active NPI
Gabriel Matthias Evans, LLBSW
- Social Worker
- Manistee, MI
National Provider Identifier
1306126164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6802086349
- Practice address
- 310 Glocheski Dr
Manistee, MI 49660-2639 - Phone
- (877) 398-2013
- NPI assigned
- Aug 25, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 6802086349 | MI | Primary |
Addresses
Primary practice location
310 Glocheski Dr
Manistee, MI 49660-2639
Mailing address
3840 Blueberry LN
Honor, MI 49640-9754
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6802086349 | Other | MI | STATE OF MICHIGAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6802086349 | MI | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314230400000",
"number": "1306126164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3840 BLUEBERRY LN",
"city": "HONOR",
"state": "MI",
"postal_code": "496409754"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "310 GLOCHESKI DR",
"city": "MANISTEE",
"state": "MI",
"postal_code": "496602639",
"telephone_number": "877-398-2013"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANS",
"first_name": "GABRIEL",
"middle_name": "MATTHIAS",
"credential": "LLBSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-08-25",
"last_updated": "2011-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6802086349",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF MICHIGAN",
"identifier": "6802086349",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Manistee, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.