Active NPI
Craig Randall Evans, MD
- Family Medicine Physician
- Edmond, OK
National Provider Identifier
1659391464
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 13180
- Practice address
- 1208 W 15TH St
Edmond, OK 73013-3001 - Phone
- (405) 340-2100
- Fax
- (405) 340-1184
- NPI assigned
- Jul 21, 2006
- Last updated
- Dec 28, 2017
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 13180 | OK | Primary |
Addresses
Primary practice location
1208 W 15TH St
Edmond, OK 73013-3001
Mailing address
4401 W Memorial Rd
#140
Oklahoma City, OK 73134-1785
Phone (405) 755-1515
Other practice location 1
1208 W 15th St
Edmond, OK 73013-3001
Phone (405) 340-2100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100255260B | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Summit Medical Center | Past | Accepting new patients |
Interoperability endpoints
- cevans344792@direct.integrisok.com
- cevans35189@directa.mercy.net
Organizations & group practices 1
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.
-
- General Acute Care Hospital
- Edmond, OK
- NPI 1356574560
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1514419200000",
"number": "1659391464",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4401 W MEMORIAL RD",
"address_2": "#140",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731341785",
"telephone_number": "405-755-1515",
"fax_number": "405-936-5211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1208 W 15TH ST",
"city": "EDMOND",
"state": "OK",
"postal_code": "730133001",
"telephone_number": "405-340-2100",
"fax_number": "405-340-1184"
}
],
"practiceLocations": [
{
"address_1": "1208 W 15th St",
"address_purpose": "LOCATION",
"city": "Edmond",
"state": "OK",
"postal_code": "730133001",
"country_code": "US",
"telephone_number": "405-340-2100",
"fax_number": "405-340-1184",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "EVANS",
"first_name": "CRAIG",
"middle_name": "RANDALL",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-21",
"last_updated": "2017-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OK",
"license": "13180",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100255260B",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Edmond, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.