Evan Jacobb Dole, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-2181 Issued in ID

Practice address

2003 Kootenai Health Way
Coeur D Alene, ID 83814-6051

Phone

(208) 625-4000

Fax

(208) 625-4432

NPI assigned

May 20, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MD, WA2 enrollments

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 2

Merit-based Incentive Payment System (MIPS)

Final score

94.27 of 100Reported as group

Quality

80.29

Promoting interoperability

100

Improvement activities

40

Cost

75.48

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Sound Physicians Emergency Medicine of Washington PLLC

  • Emergency Medicine Physician
  • Sedro Woolley, WA
  • NPI 1629532064
  Medicare reassignment
• WHC Physician Group LLC

  • General Practice Physician
  • Washington, DC
  • NPI 1700154226

  MD

  Medicare reassignment

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

{
    "created_epoch": "1621468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1780259945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2003 KOOTENAI HEALTH WAY",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838146051",
            "telephone_number": "208-625-4000",
            "fax_number": "208-625-4432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2003 KOOTENAI HEALTH WAY",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838146051",
            "telephone_number": "208-625-4000",
            "fax_number": "208-625-4432"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3520 Hwy 8",
            "address_purpose": "LOCATION",
            "city": "Deary",
            "state": "ID",
            "postal_code": "838280213",
            "country_code": "US",
            "telephone_number": "208-346-2116",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOLE",
        "first_name": "EVAN",
        "middle_name": "JACOBB",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-20",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA61569778",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-2181",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael A Dixon, M.D.
• Elaine M Dodson, CADC/LMS
• Diane Elaine Doherty
• Kieran Doherty, PA-C
• Gayle Dohrman
• Don J Schmitt MD
• Lucretia M Donahue Reed, LCPC
• Donald J Johnson DDS Inc
• Monica F Donegan, PA
• Gianna B Donnelly, PHARMD

• Physician Assistant in Coeur d'Alene, ID
• Providers in Coeur d'Alene, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; 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.
• 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.