Active NPI
Evan Richardson
- Student in an Organized Health Care Education/Training Program
- Bloomsburg, PA
National Provider Identifier
1386438224
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 549 Fair St # 61-22
Bloomsburg, PA 17815-1419 - Phone
- (570) 416-1925
- Fax
- (570) 387-2258
- NPI assigned
- Apr 7, 2025
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
549 Fair St # 61-22
Bloomsburg, PA 17815-1419
Mailing address
549 Fair St # 61-22
Bloomsburg, PA 17815-1419
Phone (570) 416-1925
Other practice location 1
480 Central Rd
Bloomsburg, PA 17815-3121
Phone (570) 416-1925
Other practice location 2
64 Rehab Ln
Danville, PA 17821-8702
Phone (570) 416-1925
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250604004336 | PA | Order and Referring Only - Physical Medicine and Rehabilitation | 3971012436 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1743984000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1743984000000",
"number": "1386438224",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "549 FAIR ST # 61-22",
"city": "BLOOMSBURG",
"state": "PA",
"postal_code": "178151419",
"telephone_number": "570-416-1925",
"fax_number": "570-387-2258"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "549 FAIR ST # 61-22",
"city": "BLOOMSBURG",
"state": "PA",
"postal_code": "178151419",
"telephone_number": "570-416-1925",
"fax_number": "570-387-2258"
}
],
"practiceLocations": [
{
"address_1": "480 Central Rd",
"address_purpose": "LOCATION",
"city": "Bloomsburg",
"state": "PA",
"postal_code": "178153121",
"country_code": "US",
"telephone_number": "570-416-1925",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "64 Rehab Ln",
"address_purpose": "LOCATION",
"city": "Danville",
"state": "PA",
"postal_code": "178218702",
"country_code": "US",
"telephone_number": "570-416-1925",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "RICHARDSON",
"first_name": "EVAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-04-07",
"last_updated": "2025-04-07",
"certification_date": "2025-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomsburg, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2025; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.