Active NPI
Evolutis, LLC
- Clinical Psychologist
- Vienna, WV
National Provider Identifier
1821657941
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- Legal business name
- EVOLUTIS, LLC
- Practice address
- 1504 Grand Central Ave
Vienna, WV 26105-1058 - Phone
- (877) 219-8726
- Fax
- (847) 960-5360
- NPI assigned
- Jun 12, 2019
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Sheel A Patel, MD
- Title
- Ceo
- Phone
- (304) 615-8102
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Psychologist | 103TA0400X | |||
| Clinical Psychologist | 103TC0700X | Primary |
Addresses
Primary practice location
1504 Grand Central Ave
Vienna, WV 26105-1058
Mailing address
PO Box 3120
Munster, IN 46321-0120
Phone (877) 219-8726
Other practice location 1
220 E Illinois St Apt 5007
Chicago, IL 60611-5134
Phone (304) 615-8102
Other practice location 2
541 Otis Bowen Dr
Munster, IN 46321-4158
Phone (219) 934-5300
Other practice location 3
1267 Willis St Ste 200
Redding, CA 96001-0400
Phone (877) 219-8726
Other practice location 4
1150 First Ave Ste 511
King Of Prussia, PA 19406-1316
Phone (877) 219-8726
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL, WI, TX, GA, MI, IN, CO, KS, OH, FL, LA
Enrollment records 11
National Provider Directory
National Provider DirectoryLocations
1267 Willis St
Redding, CA 96001
180 N Michigan Ave
Chicago, IL 60601
Phone (312) 236-4582
3030 N West Expy
Ste 200B
Oklahoma City, OK 73112
Phone (309) 665-0206
Practitioners & affiliated clinicians
Practitioners 12
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Clinical Psychologist
- Indianapolis, IN
- NPI 1073744496
-
- Clinical Psychologist
- Saint Cloud, FL
- NPI 1225447543
-
- Clinical Psychologist
- Indianapolis, IN
- NPI 1376827915
Addiction (Substance Use Disorder), MI
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1560297600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1663200000000",
"number": "1821657941",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3120",
"city": "MUNSTER",
"state": "IN",
"postal_code": "463210120",
"telephone_number": "877-219-8726"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1504 GRAND CENTRAL AVE",
"city": "VIENNA",
"state": "WV",
"postal_code": "261051058",
"telephone_number": "877-219-8726",
"fax_number": "847-960-5360"
}
],
"practiceLocations": [
{
"address_1": "220 E Illinois St Apt 5007",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "606115134",
"country_code": "US",
"telephone_number": "304-615-8102",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "541 Otis Bowen Dr",
"address_purpose": "LOCATION",
"city": "Munster",
"state": "IN",
"postal_code": "463214158",
"country_code": "US",
"telephone_number": "219-934-5300",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1267 Willis St Ste 200",
"address_purpose": "LOCATION",
"city": "Redding",
"state": "CA",
"postal_code": "960010400",
"country_code": "US",
"telephone_number": "877-219-8726",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1150 First Ave Ste 511",
"address_purpose": "LOCATION",
"city": "King Of Prussia",
"state": "PA",
"postal_code": "194061316",
"country_code": "US",
"telephone_number": "877-219-8726",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "EVOLUTIS, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2019-06-12",
"last_updated": "2022-09-15",
"certification_date": "2022-09-15",
"status": "A",
"authorized_official_last_name": "PATEL",
"authorized_official_first_name": "SHEEL",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "304-615-8102",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "103TA0400X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychologist, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychologist, Clinical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vienna, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 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.