EVANSTON CLINIC CORP (NPI# 1013916519) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013916519 |
| Entity Type | Organization |
| Organization Name | EVANSTON CLINIC CORP |
| Practice Address |
196 Arrowhead Dr Ste 8 Evanston WY 82930-8752 |
| Mailing Address |
Po Box 5009 Brentwood TN 37024-5009 |
| Practice Telephone | 3077838365 |
| Practice Fax Number | 3077838284 |
| Mailing Telephone | 6152211400 |
| Mailing Fax Number | 6154652984 |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2019-03-04 |
| Authorized Official Name | LAURA J FEY (DIRECTOR REVENUE CYCLE) |
| Authorized Official Telephone | 6152213641 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 207R00000X | Internal Medicine | WY | Allopathic & Osteopathic Physicians | |
| N | 207V00000X | Obstetrics & Gynecology | WY | Allopathic & Osteopathic Physicians | |
| N | 208600000X | Surgery | WY | Allopathic & Osteopathic Physicians | |
| N | 208800000X | Urology | WY | Allopathic & Osteopathic Physicians | |
| N | 208D00000X | General Practice | Allopathic & Osteopathic Physicians | ||
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207Q00000X | Family Medicine | WY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WY | BCBS | 06159001 | 01 |
| WY | 1013916519 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801084926 | Evanston Clinic Corp | Family Medicine | 107 N Main St, Lyman, WY 82937 | 2007-10-15 |
| Street Address |
196 ARROWHEAD DR STE 8 |
| City | EVANSTON |
| State | WY |
| Zip Code | 82930-8752 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598398935 | Colby Kim Gomez | Physical Therapist | 190 Arrowhead Dr, Evanston, Wy 82930, Evanston, WY 82930 | 2020-02-13 |
| 1164808382 | Marilyn Carol Edgeworth Tacoma | Registered Nurse | 1037 Morse Lee St, Evanston, WY 82930 | 2015-08-11 |
| 1699159723 | Impact Physical Therapy LLC | Clinic/Center | 96 Yellow Creek Road, Evanston, WY 82930 | 2015-07-18 |
| 1578942421 | Mark Carstensen | Case Manager/Care Coordinator | 219 7th Street, Evanston, WY 82930 | 2015-05-26 |
| 1013396241 | Jennifer Carstensen | Case Manager/Care Coordinator | 325 Arrowhead Drive, Evanston, WY 82930 | 2015-05-20 |
| 1780083782 | Christa Lena Barker | Nurse Practitioner | 191 Overthrust Road, Evanston, WY 82930 | 2014-08-15 |
| 1366865339 | Don Mckay Francom | Dentist | 170 Arrowhead Dr. Suite 1, Evanston, WY 82930 | 2014-01-28 |
| 1417228370 | Premier Surgical Center, LLC | Clinic/Center | 195 Overthrust Road, Evanston, WY 82930 | 2012-01-24 |
| 1588959324 | Mejia D Williams | Social Worker | 190 Overthrust Road, Evanston, WY 82930 | 2011-06-09 |
| 1225327000 | Richard Jay Capener | Family Medicine | 196 Arrowhead Dr Ste 1, Evanston, WY 82930 | 2011-04-01 |
| Find all providers in zip 82930 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689207722 | South Lincoln Hospital District | Family Medicine | 195 Feather Way Stop 100, Evanston, WY 82930-9352 | 2020-02-18 |
| 1053970442 | Wade Gilman | Family Medicine | 1650 Ridge Ave, Ste 1304, Evanston, IL 60201 | 2019-06-10 |
| 1235503459 | South Lincoln Hospital District | Family Medicine | 195 Feather Way Ste 100, Evanston, WY 82930-9352 | 2015-11-26 |
| 1194094086 | Zulfikar Esmail | Family Medicine | 1616 Forest Pl, Evanston, IL 60201-4663 | 2011-12-21 |
| 1225327000 | Richard Jay Capener | Family Medicine | 196 Arrowhead Dr Ste 1, Evanston, WY 82930 | 2011-04-01 |
| 1821280256 | Humera Khan | Family Medicine | 800 Austin St Ste 505, Evanston, IL 60202-3439 | 2007-08-09 |
| 1902934532 | Michael Kevin Rakotz | Family Medicine | 1704 Maple Ave, Suite 200, Evanston, IL 60201-3134 | 2007-03-02 |
| 1497819692 | Geeta Maker-clark | Family Medicine | 909 Davis St Ste 200, Evanston, IL 60201-3664 | 2006-12-21 |
| 1982779047 | Elena Fitchev | Family Medicine | 800 Austin St Ste 502w, Evanston, IL 60202-3445 | 2006-11-22 |
| 1063528255 | Carl Elmer Hill | Family Medicine | 841 Dodge Ave, Evanston, IL 60202 | 2006-08-22 |
| Find all providers in EVANSTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.