MRS. CARLISSA MARIE EVANS (N.P.) – Nurse Practitioner, NPI 1104114727
Nurse Practitioner
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for MRS. CARLISSA MARIE EVANS (N.P.)
4545 FULLER DR STE 325
IRVING, TX 750386530
Phone: (972) 870-5511
Fax: (972) 870-5512
Type: Location
PO BOX 1239
TROY, MI 480991239
Phone:
Type: Mailing
10300 N CENTRAL EXPY
DALLAS, TX 752318600
Phone: (469) 634-1800
Type: Mailing
1715 TEXOMA PKWY
SHERMAN, TX 750902613
Phone: (903) 487-0477
Fax: (903) 486-9844
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 3 Open Payments records for all available years, with a total value of $64.
Total Amount is formed as General ($64) + Research ($0) + Ownership ($0) = $64.
Last reported payment date: 2024-10-10 • Largest payer in this snapshot: Boston Scientific Corporation ($50).
Total Amount
$64
General + Research + Ownership
Payments
3
Total payment records
General Amount
$64
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-10-10
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Boston Scientific Corporation | $50 |
| Tactile Systems Technology Inc | $14 |
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: 2011-12-15
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 |
|---|---|---|---|---|
| I20111215000277 | I | Nurse Practitioner | TX | 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 75038)
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