NPIMap

Individual provider Active NPI

Stephen John Evan, M.D.

  • Surgery Physician
  • Boardman, OH
National Provider Identifier
1639141187
Registry record updated Feb 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
35067701 Issued in OH
Practice address
7645 Market St
Suite 200
Boardman, OH 44512-6098
Phone
(330) 707-0771
NPI assigned
Feb 7, 2006
Last updated
Feb 5, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 35067701 OH Primary

Addresses

Primary practice location

7645 Market St
Suite 200
Boardman, OH 44512-6098

Mailing address

7645 Market St
Suite 200
Boardman, OH 44512-6098
Phone (330) 707-0771

Other identifiers 2

IdentifierTypeStateIssuer
0270264MedicaidOH
311549684OtherOHOHIO BWC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120503000159 OH Practitioner - General Surgery 6305808999 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Ohio State University College of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Triad Health Services LLCGroup PAC ID 9032367917, 252 clinicians

Practice addresses (Care Compare)

7630 Southern Blvd
Youngstown, OH 44512-5633
Phone (330) 729-8000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.94 of 100Reported as group
Quality
71.12
Promoting interoperability
100
Improvement activities
40
Cost
75.36

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy96
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)24
Mastectomy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux78

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35067701OHMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Triad Health Services, LLC CurrentSince Apr 1, 2023 Accepting new patients
Comprehensive Surgical Group of Northeast Ohio LTD Surgery CurrentSince Jan 1, 2015 Accepting new patients
The Surgery Center at Southwoods, LLC Past Accepting new patients
Mercy Health Youngstown LLC Past Accepting new patients

Locations

100 Debartolo Pl
Ste 200
Youngstown, OH 44512
Phone (330) 965-7828

250 Debartolo Pl
Ste 3000
Youngstown, OH 44512
Phone (234) 287-6590

7629 Market St
Ste 250
Youngstown, OH 44512
Phone (330) 729-9480

7630 Southern Blvd
Youngstown, OH 44512
Phone (330) 729-8000

7645 Market St
Ste 200
Youngstown, OH 44512
Phone (330) 707-0771

Organizations & group practices 4

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454630400000",
    "number": "1639141187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7645 MARKET ST",
            "address_2": "SUITE 200",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445126098",
            "telephone_number": "330-707-0771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7645 MARKET ST",
            "address_2": "SUITE 200",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445126098",
            "telephone_number": "330-707-0771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVAN",
        "first_name": "STEPHEN",
        "middle_name": "JOHN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-07",
        "last_updated": "2016-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OH",
            "license": "35067701",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0270264",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO BWC",
            "identifier": "311549684",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boardman, OH

Sources for this page

Verify at the official NPI Registry.