Richard Bruce Evans, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

5601001293 Issued in MI

Practice address

19401 Hubbard Drive
Dearborn, MI 48126

Phone

(313) 982-8475

NPI assigned

Jan 29, 2007

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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 and National Provider Directory roles.

• Wellstreet Urgent Care of Michigan

  • Non-Pharmacy Dispensing Site
  • Troy, MI
  • NPI 1649952052
  NPD (past)

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1912043126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5554 E DARTMOOR DR",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481615000",
            "telephone_number": "734-457-2935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19401 HUBBARD DRIVE",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "48126",
            "telephone_number": "313-982-8475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "RICHARD",
        "middle_name": "BRUCE",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MI",
            "license": "5601001293",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Marie Estrada
• Sabreen K Ettaher, LMSW-C
• Sarah Elizabeth Etters Thomas, MS, CCC-SLP
• Aylmer D Evangelista, MD
• Aliya K Renai Evans
• Valary Michelle Evans, MD
• Everett V Bryant MD PLLC
• Breonna Everett
• Evergreen Wellness Equipment Inc
• Everwell Behavioral Health PLLC

• Surgical Physician Assistant in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Surgical Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.