Ethan Evankow, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA1241 Issued in ME

Practice address

897 W Main St
Dover Foxcroft, ME 04426-1029

Phone

(207) 564-8401

NPI assigned

Jul 7, 2017

Last updated

Jul 22, 2025By 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 4

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in ME

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

92.4

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: eevankow1150985@direct.bsmhealth.org

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.

• St. Mary's Regional Medical Center

  • General Acute Care Hospital
  • Lewiston, ME
  • NPI 1447226584
  Medicare reassignment NPD
• Emergency Medicine Services of Maine, LLC

  • Emergency Medicine Physician
  • Ellsworth, ME
  • NPI 1578032058
  Medicare reassignment
• MRH Corp.

  dba Northern Light Primary Care Dover-Foxcroft

  • Family Medicine Physician
  • Dover Foxcroft, ME
  • NPI 1548382328
  NPD (past)
• Southwestern Vermont Medical Center, Inc

  dba SVMC Orthopaedics

  • Orthopaedic Surgery Physician
  • Bennington, VT
  • NPI 1487930632
  NPD (past)

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

{
    "created_epoch": "1499385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753142400000",
    "number": "1528580966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 639601",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452639601",
            "telephone_number": "856-686-4393",
            "fax_number": "856-694-5179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "897 W MAIN ST",
            "city": "DOVER FOXCROFT",
            "state": "ME",
            "postal_code": "044261029",
            "telephone_number": "207-564-8401"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "791 Turner St Unit 2",
            "address_purpose": "LOCATION",
            "city": "Auburn",
            "state": "ME",
            "postal_code": "042106314",
            "country_code": "US",
            "telephone_number": "207-330-3900",
            "fax_number": "207-330-3940",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Bennington",
            "state": "VT",
            "postal_code": "052015004",
            "country_code": "US",
            "telephone_number": "802-447-5023",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EVANKOW",
        "first_name": "ETHAN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-07",
        "last_updated": "2025-07-22",
        "certification_date": "2025-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VT",
            "license": "055.0031348",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ME",
            "license": "PA1241",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VT",
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ME",
            "license": "PA1241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "eevankow1318159@direct-prd.goodhelpconnections.org",
            "affiliation": "N",
            "address_1": "791 Turner St Unit 2",
            "city": "Auburn",
            "state": "ME",
            "country_code": "US",
            "postal_code": "042106314",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ellen M Anderson DPM
• Sandra Engstrom, RN
• Eric Edinger Ernst, LCSW
• Essex Sreet Dental Associates,PA
• Essex Street Dental LLC
• Richard A. Evans, M.D.
• Andrew Exley
• F.I.N.D Inc.
• Jane Elizabeth Fairchild, LCSW
• Laura Ruth Feaga, PMHNP

• Medical Physician Assistant in Dover Foxcroft, ME
• Providers in Dover Foxcroft, ME by specialty
• Medical Physician Assistant in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.