Basic Information
| Provider Information | |||||||||
| NPI: | 1881866572 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EVERMAN | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6626 E. 75TH STREET | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462502790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173557199 | ||||||||
| FaxNumber: | 3173559022 | ||||||||
| Practice Location | |||||||||
| Address1: | 7910 E WASHINGTON ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462196803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173557171 | ||||||||
| FaxNumber: | 3173559022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2008 | ||||||||
| LastUpdateDate: | 11/18/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 11013878A | IN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 02003712A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P01347702 | 01 | IN | MEDICARE RR | OTHER | 201014320 | 05 | IN | MEDICAID |