Van Evanoff Jr., M.D.

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

01053652A Issued in IN

Practice address

2204 N Section St
Suite B
Sullivan, IN 47882-0010

Phone

(812) 268-2556

Fax

(812) 268-2652

NPI assigned

May 31, 2005

Last updated

May 25, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Indiana Pain and Spine Care

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Plainfield, IN
  • NPI 1568444586
  NPD (past) Authorized official
• Orthopaedic Specialists of the Carolinas, P.a.

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Winston Salem, NC
  • NPI 1124070115
  NPD (past)

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

{
    "created_epoch": "1117497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464134400000",
    "number": "1851394175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2204 N SECTION ST PO BOX 10",
            "address_2": "SUITE B",
            "city": "SULLIVAN",
            "state": "IN",
            "postal_code": "478820010",
            "telephone_number": "812-268-2556",
            "fax_number": "812-268-2652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2204 N SECTION ST",
            "address_2": "SUITE B",
            "city": "SULLIVAN",
            "state": "IN",
            "postal_code": "478820010",
            "telephone_number": "812-268-2556",
            "fax_number": "812-268-2652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANOFF",
        "first_name": "VAN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-31",
        "last_updated": "2016-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "IN",
            "license": "01053652A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "000000338733",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01625340",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200262220",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ernest Steve Dupre, MD
• Robert Ealy, APRN
• Dustin Clay Ellis, M.D.
• Jessica Mae Ellsperman, DDS
• Emerald Health & Wellness LLC
• Kevin Braun Flinn, NP
• Michelle D Gill, LPN
• Destiny Nicole Goldner, MS, LMHC-A
• Lynsey Grant
• Brian K Grindstaff, DC

• Interventional Pain Medicine Physician in Sullivan, IN
• Providers in Sullivan, IN by specialty
• Interventional Pain Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.