Jean K Evangelisti, APRN

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

002284 Issued in CT

Practice address

780 Litchfield St
Suite 200
Torrington, CT 06790-6268

Phone

(860) 489-1984

Fax

(860) 496-2195

NPI assigned

Nov 15, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Connecticut Kidney & Hypertension Specialists, LLC

  • Nephrology Physician
  • Waterbury, CT
  • NPI 1962651968
  NPD

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

{
    "created_epoch": "1132012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279843200000",
    "number": "1760464903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "780 LITCHFIELD ST",
            "address_2": "SUITE 200",
            "city": "TORRINGTON",
            "state": "CT",
            "postal_code": "067906268",
            "telephone_number": "860-489-1984",
            "fax_number": "860-496-2195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "780 LITCHFIELD ST",
            "address_2": "SUITE 200",
            "city": "TORRINGTON",
            "state": "CT",
            "postal_code": "067906268",
            "telephone_number": "860-489-1984",
            "fax_number": "860-496-2195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANGELISTI",
        "first_name": "JEAN",
        "middle_name": "K",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-11-15",
        "last_updated": "2010-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CT",
            "license": "002284",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM- INSURANCE",
            "identifier": "400002284CT01",
            "state": "DE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICARE - INSURANCE",
            "identifier": "705146",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004234481",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Energy Health & Wellness LLC
• Jeanette Epps, BA
• Michael A Ernest, DDS MS
• Robert V Erwin, LCSW
• Esthetic Family Dentistry
• Stacey R Evans, LO
• Peter Evola, P.A.
• Mareesa Fabiaschi, MSN, APRN, FNP-C
• Brooke Fairbanks, LCSW
• Family First Community Support Services LLC

• All providers in Torrington, CT
• Adult Health Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.