Evergreen Medical, LTD.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

042-618475 Issued in IL

Legal business name

EVERGREEN MEDICAL, LTD.

Doing business as

Evergreen Family Medicine

Practice address

2850 W 95TH St
Suite 403
Evergreen Park, IL 60805-2735

Phone

(708) 423-2662

Fax

(708) 422-7264

NPI assigned

Jul 1, 2005

Last updated

Mar 22, 2018By 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

John R Elsen, M.D.NPI 1437260940

Title

President

Phone

(708) 423-2662

Specialties & licenses 1

Addresses

Other names 1

• Evergreen Family Medicine Doing business as

Practitioners 1

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.

• John Robert Elsen, M.D.

  • Family Medicine Physician
  • Evergreen Park, IL
  • NPI 1437260940
  Authorized official Same address or phone

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

{
    "created_epoch": "1120176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521676800000",
    "number": "1245237460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2850 W 95TH ST",
            "address_2": "SUITE 403",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608052735",
            "telephone_number": "708-423-2662",
            "fax_number": "708-422-7264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2850 W 95TH ST",
            "address_2": "SUITE 403",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608052735",
            "telephone_number": "708-423-2662",
            "fax_number": "708-422-7264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN MEDICAL, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-01",
        "last_updated": "2018-03-22",
        "status": "A",
        "authorized_official_last_name": "ELSEN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-423-2662",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "042-618475",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Evergreen Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Evergreen Anesthesia & Pain Management Services, S.C.
• Evergreen Care Center LTD
• Evergreen Emergency Services, LTD
• Evergreen Healthcare Center, LLC
• Evergreen Living & Rehab Center LLC
• Evergreen Park Chiropractic Center Inc
• Evergreen Park Cu HS Dist 231
• Evergreen Park Pharmacy Inc (Evergreen Pharmacy)
• Evergreen Park SCH Dist 124
• Evergreen Park Spine & Injury Center PC (April J. Miller, D.C., EPSIC)

• Family Medicine Physician in Evergreen Park, IL
• Providers in Evergreen Park, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.