Individual provider Active NPI

Evan Edmund Husted, MD

  • Emergency Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1558523712
Registry record updated Aug 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
25MA08940200 Issued in NJ
Practice address
111 S 11TH St
Philadelphia, PA 19107-4824
Phone
(215) 955-9837
NPI assigned
Jun 30, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 15, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MT193861 PA
Emergency Medicine Physician 207P00000X 25MA08940200 NJ Primary

Addresses

Primary practice location

111 S 11TH St
Philadelphia, PA 19107-4824

Mailing address

134 Lake View Drive
Media, PA 19063

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110714000635 NJ Practitioner - Emergency Medicine 3072781244 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MT193861PAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Atlanticare Physician Group CurrentSince Sep 10, 2016 Accepting new patients
Atlanticare Urgent Care Physicians LLC CurrentSince Oct 1, 2016 Accepting new patients
Emergency Physician Associates of South Jersey P C Emergency Medicine CurrentSince Jun 1, 2011 Accepting new patients
Atlanticare Physician Group PA Current Accepting new patients
Atlanticare Physician Group, PA CurrentSince Sep 10, 2016 Accepting new patients

Locations

100 Townsend Ave
Berlin, NJ 08009
Phone (856) 322-3000

2500 English Creek Ave
Ste 909
Egg Harbor Twp, NJ 08234
Phone (609) 407-2380

459 Route 9 S
Little Egg Harbor Twp, NJ 08087
Phone (609) 340-7815

3131 Route 38
Ste 13
Mount Laurel, NJ 08054
Phone (856) 866-8700

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1214784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471219200000",
    "number": "1558523712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 LAKE VIEW DRIVE",
            "city": "MEDIA",
            "state": "PA",
            "postal_code": "19063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S 11TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074824",
            "telephone_number": "215-955-9837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUSTED",
        "first_name": "EVAN",
        "middle_name": "EDMUND",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-30",
        "last_updated": "2016-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "PA",
            "license": "MT193861",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NJ",
            "license": "25MA08940200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.