NPIMap

Individual provider Active NPI

Blaine Evans, DO

  • Emergency Medicine Physician
  • Rochester, MN
National Provider Identifier
1811375900
Registry record updated May 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
34.012400 Issued in OH
Practice address
210 9TH St SE
Rochester, MN 55904-6756
Phone
(507) 288-3443
NPI assigned
May 11, 2015
Last updated
May 27, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 27, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 67079 MN
Emergency Medicine Physician 207P00000X 34.012400 OH Primary

Addresses

Primary practice location

210 9TH St SE
Rochester, MN 55904-6756

Mailing address

8280 Yankee St
Centerville, OH 45458-1806
Phone (937) 436-4658

Other practice location 1

4000 Miamisburg Centerville Rd
Miamisburg, OH 45342-7615
Phone (937) 384-8791

Other practice location 2

3535 Pentagon Blvd
Beavercreek, OH 45431-1705
Phone (937) 702-4500

Other practice location 3

3535 Southern Blvd
Kettering, OH 45429-1221
Phone (937) 395-8166

Other identifiers 1

IdentifierTypeStateIssuer
0188741MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210722001857 CO Practitioner - Emergency Medicine 6103139647 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Rocky Vista University College of Osteopathic Med, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1024 S Lemay Ave
Poudre Valley Hospital
Fort Collins, CO 80524-3929
Phone (970) 495-7000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.04 of 100Reported as group
Quality
87.35
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physicians of the Rockies, PC Emergency Medicine CurrentSince Aug 1, 2021 Accepting new patients
Emergency Physicians of the Rockies, PC Emergency Medicine CurrentSince Aug 1, 2021 Accepting new patients
Fort Collins Radiologic Associates PC Past Accepting new patients

Locations

1024 S Lemay Ave
Fort Collins, CO 80524
Phone (970) 495-7000

2500 Rocky Mountain Ave
Loveland, CO 80538
Phone (970) 297-6425

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 18

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1431302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590537600000",
    "number": "1811375900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8280 YANKEE ST",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454581806",
            "telephone_number": "937-436-4658",
            "fax_number": "888-654-7267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 9TH ST SE",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559046756",
            "telephone_number": "507-288-3443"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4000 Miamisburg Centerville Rd",
            "address_purpose": "LOCATION",
            "city": "Miamisburg",
            "state": "OH",
            "postal_code": "453427615",
            "country_code": "US",
            "telephone_number": "937-384-8791",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3535 Pentagon Blvd",
            "address_purpose": "LOCATION",
            "city": "Beavercreek",
            "state": "OH",
            "postal_code": "454311705",
            "country_code": "US",
            "telephone_number": "937-702-4500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3535 Southern Blvd",
            "address_purpose": "LOCATION",
            "city": "Kettering",
            "state": "OH",
            "postal_code": "454291221",
            "country_code": "US",
            "telephone_number": "937-395-8166",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EVANS",
        "first_name": "BLAINE",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-05-11",
        "last_updated": "2020-05-27",
        "certification_date": "2020-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MN",
            "license": "67079",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "34.012400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0188741",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, MN

Sources for this page

Verify at the official NPI Registry.