NPIMap

Organization Active NPI

Evergreen Medical Center LLC

Doing business as Evergreen Primary Care

  • Emergency Medicine Physician
  • Evergreen, AL
National Provider Identifier
1356695886
Registry record updated Nov 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
EVERGREEN MEDICAL CENTER LLC
Doing business as
Evergreen Primary Care
Practice address
100 Edwina Street
Evergreen, AL 36401-3319
Phone
(251) 578-0278
Fax
(251) 578-0290
NPI assigned
Nov 6, 2012
Last updated
Nov 6, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2012

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

Authorized official

Name
Mr. James Powell
Title
Office Manager
Phone
(251) 578-0278

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU Primary

Addresses

Primary practice location

100 Edwina Street
Evergreen, AL 36401-3319

Mailing address

100 Edwina Street
Evergreen, AL 36401-3319
Phone (251) 578-0278

Other names 1

  • EVERGREEN PRIMARY CARE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080813000367 AL Part B Supplier - Clinic/Group Practice 6305942145 Receives reassigned benefits from 3 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Evergreen, AL

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/evergre-84838805

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1352160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352160000000",
    "number": "1356695886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 EDWINA STREET",
            "city": "EVERGREEN",
            "state": "AL",
            "postal_code": "364013319",
            "telephone_number": "251-578-0278",
            "fax_number": "251-578-0290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 EDWINA STREET",
            "city": "EVERGREEN",
            "state": "AL",
            "postal_code": "364013319",
            "telephone_number": "251-578-0278",
            "fax_number": "251-578-0290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-06",
        "last_updated": "2012-11-06",
        "status": "A",
        "authorized_official_last_name": "POWELL",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "251-578-0278",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EVERGREEN PRIMARY CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Evergreen, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2012; 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.