Nicholas James Evertsen, D.O.

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

OS013911 Issued in PA

Practice address

1 Guthrie SQ
Sayre, PA 18840-1625

Phone

(570) 887-2855

NPI assigned

Oct 21, 2008

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 2

Medicare fee-for-service enrollment

Enrolled in PA, NY, FL3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 3

Specialty

Plastic and Reconstructive Surgery

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Guthrie Medical Group PCGroup PAC ID 6002728656, 795 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Robert Packer Hospital Hospital, Sayre, PA, CCN 390079

Merit-based Incentive Payment System (MIPS)

Final score

87.13 of 100Reported as group

Quality

77.56

Promoting interoperability

100

Improvement activities

40

Cost

76.02

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Guthrie Medical Group, P.C.

  • Family Medicine Physician
  • Athens, PA
  • NPI 1962451153
  Medicare reassignment Care Compare group NPD
• Guthrie Medical Group, P.C.

  • Multi-Specialty Clinic/Center
  • Corning, NY
  • NPI 1134178635
  Medicare reassignment NPD
• Guthrie Clinic, LTD

  • Plastic Surgery Physician
  • Sayre, PA
  • NPI 1588616932
  NPD
• Guthrie Medical Group, P.C.

  • General Practice Physician
  • Sayre, PA
  • NPI 1245246644
  NPD
• Guthrie Medical Group, P.C.

  • Family Medicine Physician
  • Troy, PA
  • NPI 1376592493
  NPD
• Guthrie Medical Group PC

  • Clinical Medical Laboratory
  • Sayre, PA
  • NPI 1649225855
  NPD (past)

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

• Robert Packer Hospital

  • General Acute Care Hospital
  • Sayre, PA
  • NPI 1083614382
  Care Compare affiliation
• Robert Packer Hospital

  dba Robert Packer Hospital, Towanda Campus

  • General Acute Care Hospital
  • Towanda, PA
  • NPI 1134734528
  Care Compare affiliation

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

{
    "created_epoch": "1224547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617753600000",
    "number": "1881846897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 GUTHRIE SQ",
            "city": "SAYRE",
            "state": "PA",
            "postal_code": "188401625",
            "telephone_number": "570-888-5858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GUTHRIE SQ",
            "city": "SAYRE",
            "state": "PA",
            "postal_code": "188401625",
            "telephone_number": "570-887-2855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVERTSEN",
        "first_name": "NICHOLAS",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-21",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "PA",
            "license": "OS013911",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03248437",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102500574",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Endless Mountain Behavioral Health Center Inc
• Logan Ann Engle
• Pamela Jean Ennis, CRNA
• Lisa Marie Esolen, MD
• Kara Kathleen Evans, PT, DPT
• Kaila Evertts
• Regina Excell, R.N.
• Godfred Eyiah-Mensah, M.D.
• Daniel Fabian, MD
• Kyleigh Rhea Farmelo, PA-C

• Plastic Surgery Physician in Sayre, PA
• Providers in Sayre, PA by specialty
• Plastic Surgery Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.