ETHAN EVANKOW (PA) – Medical Physician Assistant, NPI 1528580966
Medical Physician Assistant
Main info
Contacts
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for ETHAN EVANKOW (PA)
C/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT
PO BOX 7291
LEWISTON, ME 042437291
Phone: (207) 777-8950
Fax: (207) 777-8800
Type: Mailing
791 TURNER ST UNIT 2
AUBURN, ME 042106314
Phone: (207) 330-3900
Fax: (207) 330-3940
Type: Location
897 W MAIN ST
DOVER FOXCROFT, ME 044261029
Phone: (207) 564-8401
Type: Location
100 Hospital Dr
Bennington, VT 052015004
Phone: (802) 447-5023
Type: Location
791 Turner St Unit 2
Auburn, ME 042106314
Phone: (207) 330-3900
Fax: (207) 330-3940
Type: Location
Southwestern Vermont Medical Center, 100, Hospital Drive, Bennington, Bennington County, Vermont, 05201, United States
BENNINGTON, VT 052015004
Phone: (603) 915-6118
Type: Mailing
PO BOX 639601
CINCINNATI, OH 452639601
Phone: (856) 686-4393
Fax: (856) 694-5179
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2021-01-13
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20210113001188 | I | Physician Assistant | ME | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 04243)
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