NPIMap

Organization Active NPI

Evergreen Medical, Inc.

Doing business as the SMART Clinic

  • Physical Medicine & Rehabilitation Physician
  • Draper, UT
National Provider Identifier
1316160534
Registry record updated Jul 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
EVERGREEN MEDICAL, INC.
Doing business as
the SMART Clinic
Practice address
96 E Kimballs LN Ste 304
Draper, UT 84020-5021
Phone
(801) 676-7627
Fax
(801) 676-7629
NPI assigned
Apr 10, 2007
Last updated
Jul 24, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2023

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

Authorized official

Name
Marci A Merrill
Title
Billing Manager
Phone
(801) 676-7627

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X NU Primary
Interventional Pain Medicine Physician 208VP0014X NU

Addresses

Primary practice location

96 E Kimballs LN Ste 304
Draper, UT 84020-5021

Mailing address

PO Box 900280
Sandy, UT 84090-0280
Phone (801) 676-7627

Other identifiers 4

IdentifierTypeStateIssuer
1649377540OtherUTDR NPI
1013980119OtherMADR NPI
1285604462OtherUTDR NPI
1750351847OtherUTDR NPI

Other names 1

  • the SMART Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040124000260 UT Part B Supplier - Clinic/Group Practice 7719889138 Receives reassigned benefits from 4 practitioners
Practice locations: Draper, UT

National Provider Directory

National Provider Directory

Locations

10011 S Centennial Pkwy
Ste 500
Sandy, UT 84070
Phone (801) 676-7627

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690156800000",
    "number": "1316160534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 900280",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840900280",
            "telephone_number": "801-676-7627",
            "fax_number": "801-676-7629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "96 E KIMBALLS LN STE 304",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840205021",
            "telephone_number": "801-676-7627",
            "fax_number": "801-676-7629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN MEDICAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2023-07-24",
        "certification_date": "2023-07-24",
        "status": "A",
        "authorized_official_last_name": "MERRILL",
        "authorized_official_first_name": "MARCI",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "801-676-7627"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR NPI",
            "identifier": "1649377540",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR NPI",
            "identifier": "1013980119",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR NPI",
            "identifier": "1285604462",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR NPI",
            "identifier": "1750351847",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "the SMART Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "the SMART Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Draper, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.