NPIMap

Organization Active NPI

Evernorth Care Providers - Tennessee PC

  • General Practice Physician
  • Orlando, FL
National Provider Identifier
1316726730
Registry record updated Jul 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
EVERNORTH CARE PROVIDERS - TENNESSEE PC
Practice address
4700 Millenia Blvd Ste 5005TH
Orlando, FL 32839-6013
Phone
(773) 292-4800
Fax
(312) 564-4059
NPI assigned
Sep 25, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2025

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

Authorized official

Name
Jacqueline D Lakes
Title
Senior Paralegal
Phone
(954) 446-0640

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

4700 Millenia Blvd Ste 5005TH
Orlando, FL 32839-6013

Mailing address

730 Cool Springs Blvd Ste 500
Franklin, TN 37067-7331
Phone (773) 292-4800

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231121000124 FL Part B Supplier - Clinic/Group Practice 7911355532 Receives reassigned benefits from 1 practitioner
Practice locations: Orlando, FL

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Evernorth Care Providers - Tennessee PC7 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

4700 Millenia Blvd
Ste 5005TH
Orlando, FL 32839
Phone (478) 365-9062

Practitioners & affiliated clinicians

Practitioners 1

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": "1695600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752451200000",
    "number": "1316726730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "730 COOL SPRINGS BLVD STE 500",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370677331",
            "telephone_number": "773-292-4800",
            "fax_number": "312-564-4059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 MILLENIA BLVD STE 5005TH",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328396013",
            "telephone_number": "773-292-4800",
            "fax_number": "312-564-4059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERNORTH CARE PROVIDERS - TENNESSEE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-25",
        "last_updated": "2025-07-14",
        "certification_date": "2025-07-14",
        "status": "A",
        "authorized_official_last_name": "LAKES",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "SENIOR PARALEGAL",
        "authorized_official_telephone_number": "954-446-0640"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2025; 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.