Active NPI
Kurt Evinger, SA-C
- Surgical Assistant
- Maple Park, IL
National Provider Identifier
1700910502
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Assistant
- License
- 238000543
- Practice address
- 14963 E County Line Rd
Maple Park, IL 60151-5200 - Phone
- (815) 766-0168
- NPI assigned
- Mar 15, 2007
- Last updated
- May 27, 2017
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Surgical Assistant | 246ZC0007X | 238000543 | IL | Primary |
Addresses
Primary practice location
14963 E County Line Rd
Maple Park, IL 60151-5200
Mailing address
14963 E County Line Rd
Maple Park, IL 60151-5200
Phone (815) 766-0168
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 238000543 | IL | MD | Surgical Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1495843200000",
"number": "1700910502",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14963 E COUNTY LINE RD",
"city": "MAPLE PARK",
"state": "IL",
"postal_code": "601515200",
"telephone_number": "815-766-0168"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14963 E COUNTY LINE RD",
"city": "MAPLE PARK",
"state": "IL",
"postal_code": "601515200",
"telephone_number": "815-766-0168"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVINGER",
"first_name": "KURT",
"name_prefix": "Mr.",
"credential": "SA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-15",
"last_updated": "2017-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "246ZC0007X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Assistant",
"state": "IL",
"license": "238000543",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maple Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 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.