NPIMap

Individual provider Active NPI

Evelyne Ndera

  • Community Health Worker
  • Phoenix, AZ
National Provider Identifier
1376139097
Registry record updated Dec 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health WorkerTaxonomy code 172V00000X
Practice address
2506 W Dunlap Ave Apt 338
Phoenix, AZ 85021-2862
Phone
(602) 907-2488
NPI assigned
Dec 16, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 16, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Worker 172V00000X Primary

Addresses

Primary practice location

2506 W Dunlap Ave Apt 338
Phoenix, AZ 85021-2862

Mailing address

2506 W Dunlap Ave Apt 338
Phoenix, AZ 85021-2862
Phone (602) 907-2488

Other identifiers 1

IdentifierTypeStateIssuer
1234MedicaidAZ

Electronic endpoints 2

TypeEndpointUseAffiliation
Other URL PHOENIX Other
CONNECT URL PHOENIX Direct

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

Practice roles

OrganizationSpecialtyStatusNew patients
Grand Canyon Behavior Health Services LLC Current Accepting new patients

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": "1608076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608076800000",
    "number": "1376139097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2506 W DUNLAP AVE APT 338",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850212862",
            "telephone_number": "602-907-2488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2506 W DUNLAP AVE APT 338",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850212862",
            "telephone_number": "602-907-2488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NDERA",
        "first_name": "EVELYNE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-12-16",
        "last_updated": "2020-12-16",
        "certification_date": "2020-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1234",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "PHOENIX",
            "affiliation": "N",
            "endpointDescription": "Healthcare",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Home health care",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "PHOENIX",
            "address_1": "2506 W Dunlap Ave Apt 338",
            "city": "Phoenix",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "850212862",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "PHOENIX",
            "affiliation": "N",
            "endpointDescription": "Healing",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Healthcare",
            "address_1": "2506 W Dunlap Ave Apt 338",
            "city": "Phoenix",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "850212862",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.