Elizabeth A Evergreen, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

345954 Issued in NY

Practice address

930 S Salina St
Syracuse, NY 13202-3530

Phone

(315) 435-6266

Fax

(315) 234-0465

NPI assigned

Jun 22, 2020

Last updated

Nov 12, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Elizabeth Anne Randall Former name

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Syracuse Community Health Center IncGroup PAC ID 0143121327, 29 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: eevergreen166225@direct.upstate.edu
• Direct secure messaging: elizabeth.randall.p1@direct.schcny.nextgenshare.com
• Direct secure messaging: erandall686091@direct.ochin.org
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Syracuse Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Syracuse, NY
  • NPI 1497796353
  Medicare reassignment Care Compare group NPD
• St Josephs Medical PC

  • Family Medicine Physician
  • Liverpool, NY
  • NPI 1942501747
  Medicare reassignment NPD
• Upstate Emergency Medicine, Inc

  • Emergency Medicine Physician
  • Syracuse, NY
  • NPI 1275589582
  Medicare reassignment NPD
• Zaki Badawy, MD PC

  • Urgent Care Clinic/Center
  • Liverpool, NY
  • NPI 1871206474
  Medicare reassignment NPD
• Syracuse Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Syracuse, NY
  • NPI 1184886988
  NPD
• Syracuse Orthopedic Specialists, PLLC

  • Orthopaedic Surgery Physician
  • Syracuse, NY
  • NPI 1669410379
  NPD (past)

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

{
    "created_epoch": "1592784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731369600000",
    "number": "1144846502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6846 BUCKLEY RD",
            "city": "NORTH SYRACUSE",
            "state": "NY",
            "postal_code": "132124275",
            "telephone_number": "315-410-6400",
            "fax_number": "315-410-6410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 S SALINA ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132023530",
            "telephone_number": "315-435-6266",
            "fax_number": "315-234-0465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVERGREEN",
        "first_name": "ELIZABETH",
        "middle_name": "A",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-22",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "345954",
            "primary": true
        },
        {
            "code": "364SF0001X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Family Health",
            "state": "NY",
            "license": "34594",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "RANDALL",
            "middle_name": "ANNE",
            "credential": "FNP-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sandra Gladys Evans, PHARMD
• Melissa Evener, CASAC II
• Nathan Gerald Everding, M.D.
• Coralee Everett
• Katherine Everett, FNP
• Evonne Everson
• Thelma Everson, RN
• Zoe Every-Baker, LMHC
• Elizabeth Evett, LMHC
• Evolve Orthopedic Specialist PLLC

• Family Nurse Practitioner in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.