NPIMap

Organization Active NPI

Evernorth Direct Health LLC

  • Clinic/Center
  • Orlando, FL
National Provider Identifier
1336009380
Registry record updated Nov 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
EVERNORTH DIRECT HEALTH LLC
Practice address
6272 Lee Vista Blvd
Orlando, FL 32822-5148
Phone
(623) 277-1190
NPI assigned
Nov 13, 2025
Last updated
Nov 13, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
EVERNORTH DIRECT HEALTH LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 13, 2025

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

Authorized official

Name
Shannon Custer
Title
Chief Operating Officer and VP
Phone
(706) 483-5099

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

6272 Lee Vista Blvd
Orlando, FL 32822-5148

Mailing address

8888 E Raintree Dr
Scottsdale, AZ 85260-3951

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2323695Evernorth Direct Health LLC6272 Lee Vista Blvd, Orlando, FL 32822Certificate of waiverMay 11, 2027
10D2339371Evernorth Direct Health LLC6272 Lee Vista Blvd BLD Accredo, Orlando, FL 32822Certificate of waiverMar 1, 2028

National Provider Directory

National Provider Directory
Tax ID family
Evernorth Direct Health LLC102 organizations share this tax ID, including this one
Part of
Evernorth Direct Health LLC

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

NPI Registry JSON

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

{
    "created_epoch": "1762992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762992000000",
    "number": "1336009380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8888 E RAINTREE DR",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852603951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6272 LEE VISTA BLVD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328225148",
            "telephone_number": "623-277-1190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERNORTH DIRECT HEALTH LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EVERNORTH DIRECT HEALTH LLC",
        "enumeration_date": "2025-11-13",
        "last_updated": "2025-11-13",
        "certification_date": "2025-11-13",
        "status": "A",
        "authorized_official_last_name": "CUSTER",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER AND VP",
        "authorized_official_telephone_number": "706-483-5099"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "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 Nov 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.