Individual provider Active NPI

Andrew Michael Evancho, M.D.

  • Diagnostic Radiology Physician
  • Knoxville, TN
National Provider Identifier
1922004597
Registry record updated Sep 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
22037 Issued in TN
Practice address
1112 E Weisgarber Rd
Ste 201
Knoxville, TN 37909-2647
Phone
(865) 558-9862
Fax
(865) 584-3478
NPI assigned
Jun 28, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 22037 TN Primary

Addresses

Primary practice location

1112 E Weisgarber Rd
Ste 201
Knoxville, TN 37909-2647

Mailing address

1112 E Weisgarber Rd
Ste 201
Knoxville, TN 37909-2647
Phone (865) 558-9862

Other identifiers 2

IdentifierTypeStateIssuer
3067058MedicaidTN
3067059MedicaidTN

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)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
22037TNMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Abercrombie Radiological Consultants Inc Diagnostic Radiology CurrentSince Aug 1, 1992 Accepting new patients
Summit Medical Group, PLLC Past Accepting new patients
Knoxville Radiological Group Associated Diagnostic Radiology PastSince Jun 30, 2001 Accepting new patients
Tennessee Cancer Specialists PLLC Past Accepting new patients
Tennessee Cancer Specialists PLLC Past Accepting new patients

Locations

1112 E Weisgarber Rd
Ste 102
Knoxville, TN 37909
Phone (865) 588-1397

1112 E Weisgarber Rd
Ste 201
Knoxville, TN 37909

1112 E Weisgarber Rd
Knoxville, TN 37909
Phone (865) 588-1397

7551 Dannaher Dr
Powell, TN 37849
Phone (865) 637-9330

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1119916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314921600000",
    "number": "1922004597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1112 E WEISGARBER RD",
            "address_2": "STE 201",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379092647",
            "telephone_number": "865-558-9862",
            "fax_number": "865-584-3478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1112 E WEISGARBER RD",
            "address_2": "STE 201",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379092647",
            "telephone_number": "865-558-9862",
            "fax_number": "865-584-3478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANCHO",
        "first_name": "ANDREW",
        "middle_name": "MICHAEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-28",
        "last_updated": "2011-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TN",
            "license": "22037",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3067058",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3067059",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2011; 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.