Individual provider Active NPI

Judith L Evans, DO

  • Family Medicine Physician
  • Clearwater, FL
National Provider Identifier
1487652467
Registry record updated Jan 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS4543 Issued in FL
Practice address
2350 Sunset Point Rd
Suite C
Clearwater, FL 33765-1443
Phone
(727) 797-3155
Fax
(727) 797-4301
NPI assigned
Jul 13, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 10, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS4543 FL Primary

Addresses

Primary practice location

2350 Sunset Point Rd
Suite C
Clearwater, FL 33765-1443

Mailing address

2350 Sunset Point Rd
Suite C
Clearwater, FL 33765-1443
Phone (727) 797-3155

Other identifiers 1

IdentifierTypeStateIssuer
054114100MedicaidFL

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)
Enrolled
Credentials
Doctor of Osteopathy

NPI Registry JSON

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

{
    "created_epoch": "1121212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420848000000",
    "number": "1487652467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2350 SUNSET POINT RD",
            "address_2": "SUITE C",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337651443",
            "telephone_number": "727-797-3155",
            "fax_number": "727-797-4301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2350 SUNSET POINT RD",
            "address_2": "SUITE C",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337651443",
            "telephone_number": "727-797-3155",
            "fax_number": "727-797-4301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "JUDITH",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-07-13",
        "last_updated": "2015-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS4543",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "054114100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearwater, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2015; 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.