Individual provider Active NPI

Tracy Sebastian Evans

  • Clinical Social Worker
  • Yellow Springs, OH
National Provider Identifier
1326584038
Registry record updated Feb 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
I.1800757 Issued in OH
Practice address
416 Xenia Ave
Yellow Springs, OH 45387-1836
Phone
(937) 767-9171
Fax
(937) 767-9175
NPI assigned
Jan 19, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X I.1800757 OH Primary

Addresses

Primary practice location

416 Xenia Ave
Yellow Springs, OH 45387-1836

Mailing address

474 N Yellow Springs St
Springfield, OH 45504-2463
Phone (937) 399-9500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180919003011 OH Practitioner - Clinical Social Worker 9830440569 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Layh and Associates IncGroup PAC ID 0749266591, 15 clinicians

Practice addresses (Care Compare)

416 Xenia Ave
Yellow Springs, OH 45387-1836
Phone (937) 767-9171

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Layh & Associates Inc CurrentSince Jul 8, 2020 Accepting new patients

Locations

416 Xenia Ave
Yellow Springs, OH 45387
Phone (937) 767-9171

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1484784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706745600000",
    "number": "1326584038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "474 N YELLOW SPRINGS ST",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455042463",
            "telephone_number": "937-399-9500",
            "fax_number": "937-342-4242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 XENIA AVE",
            "city": "YELLOW SPRINGS",
            "state": "OH",
            "postal_code": "453871836",
            "telephone_number": "937-767-9171",
            "fax_number": "937-767-9175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEBASTIAN EVANS",
        "first_name": "TRACY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-19",
        "last_updated": "2024-02-01",
        "certification_date": "2024-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.1800757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yellow Springs, OH

Sources for this page

Verify at the official NPI Registry.