Active NPI
Charles E. Evans III, D.O.
- Pulmonary Disease Physician
- Jackson, MS
National Provider Identifier
1326335902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pulmonary Disease Physician
- License
- 22904
- Practice address
- 971 Lakeland Dr Ste 1052
Jackson, MS 39216-4609 - Phone
- (601) 981-9503
- Fax
- (601) 981-7895
- NPI assigned
- Jul 5, 2011
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pulmonary Disease Physician | 207RP1001X | 22904 | MS | Primary |
Addresses
Primary practice location
971 Lakeland Dr Ste 1052
Jackson, MS 39216-4609
Mailing address
971 Lakeland Dr Ste 1052
Jackson, MS 39216-4609
Phone (601) 981-9503
Other practice location 1
2500 N State St
Dept. of Medicine
Jackson, MS 39216-4500
Phone (601) 984-5601
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22904 | Other | MS | STATE MEDICAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Pulmonary Disease
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
971 Lakeland Dr
Suite 1052
Jackson, MS 39216-4609
Phone (601) 981-9503
Hospital & facility affiliations
- St Dominic-Jackson Memorial Hospital
- Merit Health River Oaks
- Mississippi Baptist Medical Center
- King's Daughters Medical Center-Brookhaven
- Greenwood Leflore Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 75 of 100
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22904 | MS | MD | Pulmonary Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jackson Pulmonary Associates, PA | Pulmonary Disease | Current | Accepting new patients |
| St Dominic-Jackson Memorial Hospital | Past | Accepting new patients |
Locations
971 Lakeland Dr
Ste 1052
Jackson, MS 39216
Phone (601) 981-9503
Interoperability endpoints
- cevans@jpa.gwaydirect.com
- https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.323
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.
-
- Pulmonary Disease Physician
- Jackson, MS
- NPI 1174570584
-
- General Acute Care Hospital
- Jackson, MS
- NPI 1306876065
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Brookhaven, MS
- NPI 1972503464
-
- General Acute Care Hospital
- Jackson, MS
- NPI 1710909585
-
dba Merit Health River Oaks
- General Acute Care Hospital
- Flowood, MS
- NPI 1396792032
-
- General Acute Care Hospital
- Jackson, MS
- NPI 1306876065
-
dba UMMC Greenwood Hospital
- General Acute Care Hospital
- Greenwood, MS
- NPI 1699714717
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1326335902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "971 LAKELAND DR STE 1052",
"city": "JACKSON",
"state": "MS",
"postal_code": "392164609",
"telephone_number": "601-981-9503",
"fax_number": "601-981-7895"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "971 LAKELAND DR STE 1052",
"city": "JACKSON",
"state": "MS",
"postal_code": "392164609",
"telephone_number": "601-981-9503",
"fax_number": "601-981-7895"
}
],
"practiceLocations": [
{
"address_1": "2500 N State St",
"address_2": "Dept. of Medicine",
"address_purpose": "LOCATION",
"city": "Jackson",
"state": "MS",
"postal_code": "392164500",
"country_code": "US",
"telephone_number": "601-984-5601",
"fax_number": "601-984-6665",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "EVANS",
"first_name": "CHARLES",
"middle_name": "E.",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-07-05",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "MS",
"license": "22904",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE MEDICAL LICENSE",
"identifier": "22904",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.