NPIMap

Individual provider Active NPI

Michael Bogan Evan, M.D.

  • Family Medicine Physician
  • Poland, OH
National Provider Identifier
1336123124
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35053782 Issued in OH
Practice address
6615 Clingan Road
Suite a
Poland, OH 44514-4202
Phone
(330) 707-1425
Fax
(330) 757-2814
NPI assigned
Dec 5, 2005
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35053782 OH Primary

Addresses

Primary practice location

6615 Clingan Road
Suite a
Poland, OH 44514-4202

Mailing address

6615 Clingan Road
Suite a
Poland, OH 44514-4202
Phone (330) 707-1425

Other identifiers 2

IdentifierTypeStateIssuer
0778967MedicaidOH
35053782OtherOHLICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061205000062 OH Practitioner - Family Practice 5496754376 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Wright State University Boonshoft School of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novacare Rehabilitation of Ohio IncGroup PAC ID 0345159315, shared by 5 NPIs, 76 clinicians
Poland Medical Center LTDGroup PAC ID 3678572559, 10 clinicians

Practice addresses (Care Compare)

656 Youngstown Warren Rd
Niles, OH 44446-4356
Phone (330) 505-1362

6615 Clingan Rd
Suite a
Poland, OH 44514-2196
Phone (330) 757-7211

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.47 of 100Reported as group
Quality
73.84
Improvement activities
40
Cost
76.44

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35053782OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Poland Medical Center LTD Family Medicine CurrentSince Dec 10, 2006 Accepting new patients

Locations

6615 Clingan Rd
Ste A
Youngstown, OH 44514
Phone (330) 707-1425

6615 Clingan Rd
Ste C
Youngstown, OH 44514
Phone (330) 757-7888

Interoperability endpoints

  • Direct secure messaging: mevan@polandmedical.medentdirect.com

Organizations & group practices 5

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 8

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": "1133740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1336123124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6615 CLINGAN ROAD",
            "address_2": "SUITE A",
            "city": "POLAND",
            "state": "OH",
            "postal_code": "445144202",
            "telephone_number": "330-707-1425",
            "fax_number": "330-757-2814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6615 CLINGAN ROAD",
            "address_2": "SUITE A",
            "city": "POLAND",
            "state": "OH",
            "postal_code": "445144202",
            "telephone_number": "330-707-1425",
            "fax_number": "330-757-2814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVAN",
        "first_name": "MICHAEL",
        "middle_name": "BOGAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35053782",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0778967",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "35053782",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Poland, OH

Sources for this page

Verify at the official NPI Registry.