Active NPI
Jack T Evjy, M.D.
- Hematology & Oncology Physician
- Quincy, MA
National Provider Identifier
1457333023
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hematology & Oncology Physician
- License
- 27139
- Practice address
- 10 Willard St
Quincy, MA 02169-1281 - Phone
- (617) 479-1452
- Fax
- (617) 479-3500
- NPI assigned
- Nov 18, 2005
- 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 |
|---|---|---|---|---|
| Hematology & Oncology Physician | 207RH0003X | 27139 | MA | Primary |
Addresses
Primary practice location
10 Willard St
Quincy, MA 02169-1281
Mailing address
10 Willard St
Quincy, MA 02169-1281
Phone (617) 479-1437
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14331 | Other | MA | HARVARD PILGRIM |
| 2093472 | Medicaid | MA | |
| M07140 | Other | MA | BLUE CROSS BLUE SHIELD |
| 27139 | Other | MA | TUFTS HEALTH CARE |
| 92915 | Other | MA | AETNA US HEALTH |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27139 | MA | MD | Hematology & Oncology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1390262400000",
"number": "1457333023",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 WILLARD ST",
"city": "QUINCY",
"state": "MA",
"postal_code": "021691281",
"telephone_number": "617-479-1437",
"fax_number": "617-479-3500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 WILLARD ST",
"city": "QUINCY",
"state": "MA",
"postal_code": "021691281",
"telephone_number": "617-479-1452",
"fax_number": "617-479-3500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVJY",
"first_name": "JACK",
"middle_name": "T",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-18",
"last_updated": "2014-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "207RH0003X",
"taxonomy_group": "",
"desc": "Internal Medicine, Hematology & Oncology",
"state": "MA",
"license": "27139",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM",
"identifier": "14331",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2093472",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "M07140",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS HEALTH CARE",
"identifier": "27139",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA US HEALTH",
"identifier": "92915",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Quincy, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.