Individual provider Active NPI

Boyd D Evans Jr., MD

  • Family Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1790760296
Registry record updated Jan 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME89795 Issued in FL
Practice address
12276 San Jose Blvd Ste 617
Jacksonville, FL 32223-8672
Phone
(904) 262-9075
Fax
(904) 262-9076
NPI assigned
Dec 7, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME89795 FL Primary

Addresses

Primary practice location

12276 San Jose Blvd Ste 617
Jacksonville, FL 32223-8672

Mailing address

2675 Winkler Ave FL 2
Fort Myers, FL 33901-9342
Phone (877) 856-3774

Other identifiers 5

IdentifierTypeStateIssuer
298353OtherFLAVMED
4881981OtherFLCIGNA
7213790OtherFLAETNA
29493OtherFLBCBS
301810OtherFLHEALTHEASE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051013000203 FL Practitioner - Family Practice 1254356835 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
JC Edwards School of Medicine, Marshall University, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Millennium Physician Group LLCGroup PAC ID 9830244433, 976 clinicians

Practice addresses (Care Compare)

10131 San Jose Blvd
Suite 24
Jacksonville, FL 32257-5857
Phone (904) 337-2055

1065 Tamiami TRL N
Nokomis, FL 34275-2144
Phone (941) 477-2364

12276 San Jose Blvd
Suite 617
Jacksonville, FL 32223-8672
Phone (904) 262-9075

12311 San Jose Blvd
Jacksonville, FL 32223-2673
Phone (904) 262-7211

19531 Cochran Blvd
Port Charlotte, FL 33948-2081
Phone (941) 255-3535

2675 Winkler Ave
Fort Myers, FL 33901-9328

2675 Winkler Avenue
Suite 200
Fort Myers, FL 33901-9328

Hospital & facility affiliations

  • Brooks Rehabilitation Home Health Home health agency, Jacksonville, FL, CCN 103174
  • Pinnacle Home Care Home health agency, Ormond Beach, FL, CCN 108499
  • Baptist Health Medical Center - Jacksonville Hospital, Jacksonville, FL, CCN 100088
  • HCA Florida Memorial Hospital Hospital, Jacksonville, FL, CCN 100179
  • Ascension St Vincent'S Riverside Hospital, Jacksonville, FL, CCN 100040
  • Brooks Rehabilitation Hospital University Campus Inpatient rehabilitation facility, Jacksonville, FL, CCN 103039

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Millennium Physician Group LLC Family Medicine CurrentSince Oct 3, 2022 Accepting new patients
Millennium Physician Group LLC Family Medicine CurrentSince Oct 3, 2022 Accepting new patients
Memorial Urgent Care Mandarin LLC Family Medicine Past Accepting new patients

Locations

2675 Winkler Ave
Fl 2
Fort Myers, FL 33901
Phone (855) 979-5700

12276 San Jose Blvd
Ste 617
Jacksonville, FL 32223
Phone (904) 262-9075

19531 Cochran Blvd
Pt Charlotte, FL 33948
Phone (941) 255-3535

Interoperability endpoints

  • Direct secure messaging: boyd.evans.jr.1@4290.direct.athenahealth.com

Organizations & group practices 3

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.

Hospital & facility affiliations 8

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": "1133913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704240000000",
    "number": "1790760296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2675 WINKLER AVE FL 2",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339019342",
            "telephone_number": "877-856-3774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12276 SAN JOSE BLVD STE 617",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322238672",
            "telephone_number": "904-262-9075",
            "fax_number": "904-262-9076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "BOYD",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-07",
        "last_updated": "2024-01-03",
        "certification_date": "2024-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME89795",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVMED",
            "identifier": "298353",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "4881981",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7213790",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "29493",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHEASE",
            "identifier": "301810",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.