NPIMap

Individual provider Active NPI

Ryan Scott Evans, D.O.

  • Internal Medicine Physician
  • Conneaut Lake, PA
National Provider Identifier
1346508793
Registry record updated Jul 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
OS016739 Issued in PA
Practice address
12387 Conneaut Lake Rd
Conneaut Lake, PA 16316-4203
Phone
(814) 382-0221
Fax
(814) 382-0231
NPI assigned
Apr 23, 2012
Last updated
Jul 6, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X OT014474 PA
Internal Medicine Physician 207R00000X OS016739 PA Primary

Addresses

Primary practice location

12387 Conneaut Lake Rd
Conneaut Lake, PA 16316-4203

Mailing address

1034 Grove St
Meadville, PA 16335-2945
Phone (814) 382-0221

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20150714001532 PA Practitioner - Internal Medicine 4789821885 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Lake Erie College of Osteopathic Medicine, Erie, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novacare Outpatient Rehabilitation East, Inc.Group PAC ID 3678480290, shared by 15 NPIs, 493 clinicians
Primary Care ServicesGroup PAC ID 0244452258, 32 clinicians
Mrs Physical TherapyGroup PAC ID 0042128407, 168 clinicians

Practice addresses (Care Compare)

1012 Water St
Meadville, PA 16335-3468
Phone (814) 337-2345

12387 Conneaut Lake Rd
Conneaut Lake, PA 16316-4203
Phone (814) 373-4298

4538 Peach St
Erie, PA 16509-1364
Phone (814) 864-6650

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS016739PAMDInternal Medicine Physician
OT014474PAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Primary Care Services Internal Medicine CurrentSince Aug 1, 2015 Accepting new patients
Wesbury United Methodist Community Past Accepting new patients
Meadville Physician Services Internal Medicine Past Accepting new patients

Locations

12387 Conneaut Lake Rd
Conneaut Lake, PA 16316
Phone (814) 373-4298

1034 Grove St
Meadville, PA 16335
Phone (814) 333-5728

Interoperability endpoints

  • Direct secure messaging: revans@fcim.gwaydirect.com
  • Direct secure messaging: ryan.s.evans@directaddress.net

Organizations & group practices 4

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 10

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": "1335139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625529600000",
    "number": "1346508793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1034 GROVE ST",
            "city": "MEADVILLE",
            "state": "PA",
            "postal_code": "163352945",
            "telephone_number": "814-382-0221",
            "fax_number": "814-382-0231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12387 CONNEAUT LAKE RD",
            "city": "CONNEAUT LAKE",
            "state": "PA",
            "postal_code": "163164203",
            "telephone_number": "814-382-0221",
            "fax_number": "814-382-0231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "RYAN",
        "middle_name": "SCOTT",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-23",
        "last_updated": "2021-07-06",
        "certification_date": "2021-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "OT014474",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "OS016739",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conneaut Lake, PA

Sources for this page

Verify at the official NPI Registry.