NPIMap

Organization Active NPI

Evanston Internal Medicine Assoc.

Doing business as Evanston Internal Medicine Associates

  • Internal Medicine Physician
  • Evanston, WY
National Provider Identifier
1619165719
Registry record updated Nov 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
3812A Issued in WY
Legal business name
EVANSTON INTERNAL MEDICINE ASSOC.
Doing business as
Evanston Internal Medicine Associates
Practice address
150 Arrowhead Dr
Evanston, WY 82930-9353
Phone
(307) 789-0524
Fax
(307) 789-6398
NPI assigned
Oct 15, 2007
Last updated
Nov 30, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2015

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

Authorized official

Name
Dr. Thomas J Simon, MDNPI 1609883453
Title
President
Phone
(307) 789-0524

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 3812A WY Primary

Addresses

Primary practice location

150 Arrowhead Dr
Evanston, WY 82930-9353

Mailing address

150 Arrowhead Dr
Evanston, WY 82930-9353
Phone (307) 789-0524

Other names 1

  • Evanston Internal Medicine Associates Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1192406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1448841600000",
    "number": "1619165719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 ARROWHEAD DR",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "829309353",
            "telephone_number": "307-789-0524",
            "fax_number": "307-789-6398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 ARROWHEAD DR",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "829309353",
            "telephone_number": "307-789-0524",
            "fax_number": "307-789-6398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVANSTON INTERNAL MEDICINE ASSOC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-15",
        "last_updated": "2015-11-30",
        "status": "A",
        "authorized_official_last_name": "SIMON",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "307-789-0524",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WY",
            "license": "3812A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evanston Internal Medicine Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Evanston, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 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.