NPIMap

Organization Active NPI

Evansville Primary Care LLC

Doing business as Evansville Primary Care

  • Family Medicine Physician
  • Evansville, IN
National Provider Identifier
1629027800
Registry record updated Aug 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
EVANSVILLE PRIMARY CARE LLC
Doing business as
Evansville Primary Care
Practice address
4933 E Plaza East Blvd
Evansville, IN 47715-2813
Phone
(812) 479-6907
Fax
(812) 479-6967
NPI assigned
May 8, 2006
Last updated
Aug 1, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2023

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

Authorized official

Name
Kaylynn Cantacessi
Title
Manager
Phone
(812) 479-6907

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NU
Family Medicine Physician 207Q00000X NU Primary
Pediatrics Physician 208000000X NU

Addresses

Primary practice location

4933 E Plaza East Blvd
Evansville, IN 47715-2813

Mailing address

4933 E Plaza East Blvd
Evansville, IN 47715-2813
Phone (812) 401-8720

Other identifiers 2

IdentifierTypeStateIssuer
1912987363MedicaidIN
200321590MedicaidIN

Other names 2

  • Evansville Primary Care Doing business as
  • Douglas S Palmenter MD LLC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060323000104 IN Part B Supplier - Clinic/Group Practice 7416965199 Receives reassigned benefits from 8 practitioners
Practice locations: Evansville, IN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D0361707Evansville Primary Care, LLC4933 E Plaza East Blvd, Evansville, IN 47715Certificate of waiverSep 14, 2026

National Provider Directory

National Provider Directory

Locations

989A S Kenmore Dr
Evansville, IN 47714
Phone (812) 479-6907

Practitioners & affiliated clinicians

Practitioners 8

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": "1147046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690848000000",
    "number": "1629027800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4933 E PLAZA EAST BLVD",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477152813",
            "telephone_number": "812-401-8720",
            "fax_number": "812-479-6967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4933 E PLAZA EAST BLVD",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477152813",
            "telephone_number": "812-479-6907",
            "fax_number": "812-479-6967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVANSVILLE PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-08",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A",
        "authorized_official_last_name": "CANTACESSI",
        "authorized_official_first_name": "KAYLYNN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "812-479-6907"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1912987363",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200321590",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evansville Primary Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Evansville Primary Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Douglas S Palmenter MD LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Evansville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.