Active NPI
Evan Blackwell, D.D.S.
- Periodontics
- Pflugerville, TX
National Provider Identifier
1588072987
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 32883
- Practice address
- 2911 A W Grimes Blvd Ste 106
Pflugerville, TX 78660-5459 - Phone
- (512) 337-2578
- NPI assigned
- Jul 29, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 32883 | TX | |
| Dentist | 122300000X | D10343 | OR | |
| Periodontics | 1223P0300X | 32883 | TX | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
2911 A W Grimes Blvd Ste 106
Pflugerville, TX 78660-5459
Mailing address
10430 Morado Cir Apt 2030
Austin, TX 78759-5669
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190411001432 | TX | Order and Referring Only - Dentist | 3971844325 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D10343 | OR | MD | Dentist |
| 32883 | TX | MD | Ambulatory Care Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1406592000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690416000000",
"number": "1588072987",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10430 MORADO CIR APT 2030",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787595669"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2911 A W GRIMES BLVD STE 106",
"city": "PFLUGERVILLE",
"state": "TX",
"postal_code": "786605459",
"telephone_number": "512-337-2578"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKWELL",
"first_name": "EVAN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-07-29",
"last_updated": "2023-07-27",
"certification_date": "2023-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "32883",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "D10343",
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "TX",
"license": "32883",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pflugerville, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2023; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.