Active NPI
Jason William Evison, DDS
- Dentist
- Ketchikan, AK
National Provider Identifier
1871781625
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 1235
- Practice address
- 1621 Tongass Ave
Suite 103
Ketchikan, AK 99901-6013 - Phone
- (907) 225-8228
- NPI assigned
- Oct 5, 2007
- Last updated
- Jun 22, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 1235 | AK | Primary |
Addresses
Primary practice location
1621 Tongass Ave
Suite 103
Ketchikan, AK 99901-6013
Mailing address
1621 Tongass Ave
Suite 103
Ketchikan, AK 99901-6013
Phone (907) 225-8228
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DD0034 | Medicaid | AK | |
| 1235 | Other | AK | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jason W. Evison, D.D.S., P.C. | Past | Accepting new patients | |
| Thomas B. Nordtvedt, DDS, Apc | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- General Practice Dentistry
- Ketchikan, AK
- NPI 1205147444
-
- General Practice Dentistry
- Ketchikan, AK
- NPI 1952482572
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1191542400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1277164800000",
"number": "1871781625",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1621 TONGASS AVE",
"address_2": "SUITE 103",
"city": "KETCHIKAN",
"state": "AK",
"postal_code": "999016013",
"telephone_number": "907-225-8228"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1621 TONGASS AVE",
"address_2": "SUITE 103",
"city": "KETCHIKAN",
"state": "AK",
"postal_code": "999016013",
"telephone_number": "907-225-8228"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVISON",
"first_name": "JASON",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-10-05",
"last_updated": "2010-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AK",
"license": "1235",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "DD0034",
"state": "AK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "1235",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ketchikan, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.