Individual provider Active NPI

Evan C. Nelson, PA

  • Physician Assistant
  • Muscatine, IA
National Provider Identifier
1396092359
Registry record updated Apr 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
002293 Issued in IA
Practice address
1518 Mulberry Ave
Muscatine, IA 52761-3433
Phone
(563) 262-4110
Fax
(563) 264-0166
NPI assigned
Aug 9, 2012
Last updated
Apr 23, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 002293 IA Primary

Addresses

Primary practice location

1518 Mulberry Ave
Muscatine, IA 52761-3433

Mailing address

1518 Mulberry Ave
Muscatine, IA 52761-3433
Phone (563) 264-9508

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA, IL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20121031000644 IA Practitioner - Physician Assistant 3476703281 Reassigns benefits to 1 organization
I20180411000017 IL Practitioner - Physician Assistant 3476703281 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

106 19TH Ave
Suite 103
Moline, IL 61265-3700
Phone (309) 779-7050

3904 16TH St
Moline, IL 61265-1275

3912 16TH St
Moline, IL 61265-1275
Phone (309) 581-7600

3924 16TH St
Moline, IL 61265-1275
Phone (309) 779-5260

600 N College Ave
Suite 120
Geneseo, IL 61254-1095
Phone (309) 944-5342

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
002293IAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Iowa Physicians Clinic Medical Foundation Physician Assistant CurrentSince Jan 1, 2013 Accepting new patients
St Luke's Methodist Hospital Current Accepting new patients
Iowa Physicians Clinic Medical Foundation CurrentSince Jan 1, 2013 Accepting new patients
Trinity Medical Center Physician Assistant Past Accepting new patients

Locations

4480 Utica Ridge Rd
Ste 160
Bettendorf, IA 52722
Phone (563) 742-5950

4480 Utica Ridge Rd
Ste 2230
Bettendorf, IA 52722
Phone (563) 742-5150

1518 Mulberry Ave
Muscatine, IA 52761
Phone (563) 262-4110

600 N College Ave
Ste 120
Geneseo, IL 61254
Phone (309) 944-5342

3904 16th St
Ste C
Moline, IL 61265
Phone (309) 581-7610

Interoperability endpoints

  • Direct secure messaging: enelson162139@direct.unitypoint.org

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 1

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": "1344470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366675200000",
    "number": "1396092359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1518 MULBERRY AVE",
            "city": "MUSCATINE",
            "state": "IA",
            "postal_code": "527613433",
            "telephone_number": "563-264-9508",
            "fax_number": "563-264-0166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1518 MULBERRY AVE",
            "city": "MUSCATINE",
            "state": "IA",
            "postal_code": "527613433",
            "telephone_number": "563-262-4110",
            "fax_number": "563-264-0166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "EVAN",
        "middle_name": "C.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-09",
        "last_updated": "2013-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "002293",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Muscatine, IA

Sources for this page

Verify at the official NPI Registry.