NPIMap

Individual provider Active NPI

Robert James Evans III, MD

  • Urology Physician
  • Winston Salem, NC
National Provider Identifier
1477549707
Registry record updated Dec 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
38610 Issued in NC
Practice address
140 Charlois Blvd
Winston Salem, NC 27103-1522
Phone
(336) 716-2255
Fax
(336) 716-9042
NPI assigned
Sep 22, 2005
Sex
Male
Sole proprietor
No

Organizations & group practices 19

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 19

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Jefferson Medical College of Thomas Jefferson University, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wake Forest University Health Sciences 2,633 clinicians

Practice addresses (Care Compare)

140 Charlois Blvd
Winston Salem, NC 27103-1522
Phone (336) 716-4131

Medical Ctr Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-2734

Hospital & facility affiliations

  • North Carolina Baptist Hospital Hospital, Winston-Salem, NC, CCN 340047

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091208000017 NC Practitioner - Urology 9931248754 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
38610NCMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest University Health Sciences CurrentSince Dec 1, 2009 Accepting new patients
Piedmont Stone Center PLLC Urology CurrentSince Nov 1, 2010 Accepting new patients
Wake Forest University Health Sciences CurrentSince Dec 1, 2009 Accepting new patients
Urology Specialists of the Carolinas PLLC Urology Past Accepting new patients

Locations

140 Charlois Blvd
Winston Salem, NC 27103
Phone (336) 716-4131

3333 Silas Creek Pkwy
Winston Salem, NC 27103
Phone (336) 277-8800

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

1907 S Hawthorne Rd
Winston Salem, NC 27103

Interoperability endpoints

  • Direct secure messaging: revans2754184@carolinashealthcaresystem.direct-ci.com

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 38610 NC Primary

Addresses

NPPES NPI Registry

Primary practice location

140 Charlois Blvd
Winston Salem, NC 27103-1522

Mailing address

PO Box 344
Winston Salem, NC 27102-0344
Phone (336) 716-2255

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
8930941MedicaidNC
30941OtherNCBLUE CROSS BLUE SHIELD

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 14, 2010.

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292284800000",
    "number": "1477549707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 344",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271020344",
            "telephone_number": "336-716-2255",
            "fax_number": "336-716-9042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 CHARLOIS BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271031522",
            "telephone_number": "336-716-2255",
            "fax_number": "336-716-9042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "ROBERT",
        "middle_name": "JAMES",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-22",
        "last_updated": "2010-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NC",
            "license": "38610",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8930941",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "30941",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.