Evergreen Endoscopy Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

EVERGREEN ENDOSCOPY CENTER, LLC

Practice address

2400 Tamarack Avenue
Suite 100
South Windsor, CT 06074

Phone

(860) 644-7336

NPI assigned

Jun 9, 2008

Last updated

Nov 15, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

William A Wollman

Title

Executive Director

Phone

(860) 533-2123

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Listed as

Evergreen Endoscopy Center LLCCCN 07C0001052

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Joseph L Ianello, MD

  • Gastroenterology Physician
  • Enfield, CT
  • NPI 1902900525
  NPD
• Steven H Brown, M.D.

  • Colon & Rectal Surgery Physician
  • Plainville, CT
  • NPI 1871555771
  NPD (past)

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

{
    "created_epoch": "1212969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510704000000",
    "number": "1093974602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 TAMARACK AVENUE",
            "address_2": "SUITE 100",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "06074",
            "telephone_number": "860-644-7336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 TAMARACK AVENUE",
            "address_2": "SUITE 100",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "06074",
            "telephone_number": "860-644-7336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN ENDOSCOPY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-09",
        "last_updated": "2017-11-15",
        "status": "A",
        "authorized_official_last_name": "WOLLMAN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "860-533-2123"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QE0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Endoscopy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathlene Timoteo Emond, LAC
• Enhancing Behavioral Choices
• Susan Evans, OD
• M Jeanne Evenson, AU.D.
• Evergreen Dental Group, LLC
• Evergreen Imaging Center, LLC
• Family Transitions Psychotherapy
• Christine H Farber, PH.D.
• Farmington Valley Dermatology and Surgery, LLC
• Sarah Ashley Farnsworth, OTR

• Ambulatory Surgical Clinic/Center in South Windsor, CT
• Providers in South Windsor, CT by specialty
• Ambulatory Surgical Clinic/Center in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.