Mackenzie Rick Evans

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

541 S Ham LN
Lodi, CA 95242-3530

Phone

(209) 747-7147

Fax

(209) 224-5076

NPI assigned

Oct 16, 2020

Last updated

Oct 26, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• Aegis Treatment Centers, LLC

  dba dba: Healthy Connections

  • Methadone Clinic
  • Lodi, CA
  • NPI 1649669979
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603670400000",
    "number": "1477151843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 S HAM LN STE A&B",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952423530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "541 S HAM LN",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952423530",
            "telephone_number": "209-747-7147",
            "fax_number": "209-224-5076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "MACKENZIE",
        "middle_name": "RICK",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-16",
        "last_updated": "2020-10-26",
        "certification_date": "2020-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jasmine Miriam Esmailzadeh
• Daniela Espana, DDS
• Dulce Espinoza
• Amanda Lyn Estep
• Mara Kamila A Estoesta, DMD
• Scott A Evans, D.O.M., L.AC.
• Evergreen Pharmaceutical of California, LLC (Omnicare of Northern California)
• Excel Rehab Physical Therapy Inc
• Express Ways Logistics
• Rhonda Eyzaguirre, PHD, LEP, NCSP

• Addiction (Substance Use Disorder) Counselor in Lodi, CA
• Providers in Lodi, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 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.