Evanston Hospital Corporation

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

Legal business name

EVANSTON HOSPITAL CORPORATION

Doing business as

Evanston Regional Hosp - ER Dept

Practice address

190 Arrowhead Dr
Evanston, WY 82930-9266

Phone

(307) 783-8161

Fax

(307) 783-8237

NPI assigned

Jun 21, 2006

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michael Portacci

Title

President

Phone

(615) 465-7000

Specialties & licenses 1

Addresses

Other names 1

• Evanston Regional Hosp - ER Dept Doing business as

Medicare fee-for-service enrollment

Enrolled in WY

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Evanston Hospital Corporation

  • Certified Registered Nurse Anesthetist
  • Evanston, WY
  • NPI 1013288836

  O20040609001235

  Same enrollment
• Evanston Hospital Corporation

  • Family Medicine Physician
  • Lyman, WY
  • NPI 1366989014

  O20040609001235

  Same enrollment

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1801832548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60000",
            "address_2": "FILE 0074044",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941600001",
            "telephone_number": "800-819-2547",
            "fax_number": "423-899-5295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 ARROWHEAD DR",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "829309266",
            "telephone_number": "307-783-8161",
            "fax_number": "307-783-8237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVANSTON HOSPITAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-21",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "PORTACCI",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-465-7000"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evanston Regional Hosp - ER Dept",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Evanston Family Foot Care
• Evanston Hospital Corporation
• Evanston Hospital Corporation (Evanston Dialysis Center)
• Evanston Hospital Corporation (Evanston Regional Hospital)
• Evanston Hospital Corporation (Evanston Regional Hospital)
• Evanston Internal Medicine Assoc. (Evanston Internal Medicine Associates)
• Evanston Regional Physicians LLC
• Evanston Surgical Center LLC
• Evergreen Counseling
• Kenadee Eyre

• Emergency Medicine Physician in Evanston, WY
• Providers in Evanston, WY by specialty
• Emergency Medicine Physician in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.