Active NPI
Bruce M Everson, CSAC, SAP
- Addiction (Substance Use Disorder) Counselor
- Eau Claire, WI
National Provider Identifier
1952483273
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 1997
- Practice address
- 2620 Stein Blvd
Eau Claire, WI 54701-6201 - Phone
- (715) 836-0064
- Fax
- (715) 836-0065
- NPI assigned
- Oct 19, 2006
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 1997 | WI | Primary |
Addresses
Primary practice location
2620 Stein Blvd
Eau Claire, WI 54701-6201
Mailing address
2620 Stein Blvd
Eau Claire, WI 54701-6201
Phone (715) 836-0064
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39364700 | Medicaid | WI |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1997 | WI | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1434499200000",
"number": "1952483273",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2620 STEIN BLVD",
"city": "EAU CLAIRE",
"state": "WI",
"postal_code": "547016201",
"telephone_number": "715-836-0064",
"fax_number": "715-836-0065"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2620 STEIN BLVD",
"city": "EAU CLAIRE",
"state": "WI",
"postal_code": "547016201",
"telephone_number": "715-836-0064",
"fax_number": "715-836-0065"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVERSON",
"first_name": "BRUCE",
"middle_name": "M",
"credential": "CSAC, SAP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-19",
"last_updated": "2015-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WI",
"license": "1997",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39364700",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eau Claire, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.