Active NPI
Lisa Rachelle Evenson, PA-C
- Medical Physician Assistant
- Castle Rock, CO
National Provider Identifier
1467523530
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 2242
- Practice address
- 1175 S Perry St
Suite 200
Castle Rock, CO 80104-1969 - Phone
- (303) 688-3434
- Fax
- (303) 688-4454
- NPI assigned
- Nov 12, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 2242 | CO | Primary |
Addresses
Primary practice location
1175 S Perry St
Suite 200
Castle Rock, CO 80104-1969
Mailing address
1175 S Perry St
Suite 200
Castle Rock, CO 80104-1969
Phone (303) 688-3434
Other names 1
- Miss Lisa Rachelle Nelson
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
- HHS exclusion list flag
- CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2242 | CO | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Genesis Family Health Center, PLC | Past | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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- Saint Joseph, MI
- NPI 1881786085
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1357084800000",
"number": "1467523530",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1175 S PERRY ST",
"address_2": "SUITE 200",
"city": "CASTLE ROCK",
"state": "CO",
"postal_code": "801041969",
"telephone_number": "303-688-3434",
"fax_number": "303-688-4454"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1175 S PERRY ST",
"address_2": "SUITE 200",
"city": "CASTLE ROCK",
"state": "CO",
"postal_code": "801041969",
"telephone_number": "303-688-3434",
"fax_number": "303-688-4454"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVENSON",
"first_name": "LISA",
"middle_name": "RACHELLE",
"name_prefix": "Mrs.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-12",
"last_updated": "2013-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "CO",
"license": "2242",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "LISA",
"last_name": "NELSON",
"middle_name": "RACHELLE",
"prefix": "MISS",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Castle Rock, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.