NPIMap

Organization Active NPI

Everside Health, LLC

  • Primary Care Clinic/Center
  • Defiance, OH
National Provider Identifier
1083018535
Registry record updated Jul 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
EVERSIDE HEALTH, LLC
Practice address
25568 Elliott Rd
Defiance, OH 43512-9003
Phone
(419) 782-2147
Fax
(419) 782-2157
NPI assigned
Oct 13, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jill Johnson Patton
Title
Director of Risk Management
Phone
(704) 936-5546

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

25568 Elliott Rd
Defiance, OH 43512-9003

Mailing address

4651 Charlotte Park Dr Ste 300
Charlotte, NC 28217-1916
Phone (704) 936-5546

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D2089783Everside Health and Wellness Center25568 Elliott Road, Defiance, OH 43512Provider-performed microscopyJul 31, 2027

National Provider Directory

National Provider Directory
Tax ID family
Everside Health LLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

800 N Clinton St
Ste B
Defiance, OH 43512
Phone (419) 782-2147

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1413158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658966400000",
    "number": "1083018535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4651 CHARLOTTE PARK DR STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282171916",
            "telephone_number": "704-936-5546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25568 ELLIOTT RD",
            "city": "DEFIANCE",
            "state": "OH",
            "postal_code": "435129003",
            "telephone_number": "419-782-2147",
            "fax_number": "419-782-2157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERSIDE HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-13",
        "last_updated": "2022-07-28",
        "certification_date": "2022-07-28",
        "status": "A",
        "authorized_official_last_name": "PATTON",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "JOHNSON",
        "authorized_official_title_or_position": "DIRECTOR OF RISK MANAGEMENT",
        "authorized_official_telephone_number": "704-936-5546"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Defiance, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.