NPIMap

Organization Active NPI

Evergreen Medical Center LLC

  • Rural Health Clinic/Center
  • Evergreen, AL
National Provider Identifier
1427366871
Registry record updated Mar 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
EVERGREEN MEDICAL CENTER LLC
Practice address
100 Edwina Street
Evergreen, AL 36401-3319
Phone
(251) 578-0278
Fax
(251) 578-0290
NPI assigned
Sep 20, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2012

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

Authorized official

Name
Sharon Jones
Title
Chief Financial Officer
Phone
(251) 578-2480

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

100 Edwina Street
Evergreen, AL 36401-3319

Mailing address

PO Box 706
Evergreen, AL 36401-0706
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 AL2 enrollments

Enrollment records 2

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
O20110322001092 AL Part A Provider - Rural Health Clinic 6305942145 Practice locations: Evergreen, AL

Rural health clinic certification: CCN 013450

Legal name
EVERGREEN MEDICAL CENTER LLC
Doing business as
EVERGREEN PRIMARY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 31, 2011
Last certification
Sep 12, 2025
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Nov 14, 2006 in AL
Enrollment address
102 Edwina St
Evergreen, AL 36401-3319
Related CCNs
010148

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 2

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

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
01D2173011Evergreen Primary Care102 Edwina Street, Evergreen, AL 36401Certificate of waiverOct 2, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kenneth Jeremy Craig Individual Corporate OfficerCfo Apr 1, 2020
Melissa Dunn Individual Corporate DirectorChief Operations Officer Jun 28, 2018
W-2 Managing EmployeeChief Operations Officer Jun 28, 2018
Evergreen Medical Center LLC Organization, Evergreen, AL 5% Or Greater Direct Ownership Interest Feb 1, 2008
Thomas McLendon Individual Corporate OfficerChief Executive Officer Jun 28, 2018
W-2 Managing EmployeeChief Executive Officer Jun 28, 2018
James M Scott Individual 5% Or Greater Direct Ownership Interest Feb 1, 2007

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Evergreen Medical CenterEvergreen, AL, CCN 010148 Hospital 5% Or Greater Direct Ownership Interest Feb 1, 2008
Evergreen Medical Center Swing Bed UnitEvergreen, AL, CCN 01U148 Hospital 5% Or Greater Direct Ownership Interest Feb 1, 2008
Evergreen Home CareEvergreen, AL, CCN 017106 Home health agency 5% Or Greater Direct Ownership Interest Feb 1, 2008
Evergreen Medical Center LLCGeorgiana, AL, CCN 013499 Rural health clinic 5% Or Greater Direct Ownership Interest Feb 1, 2008

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 4

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": "1284940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332806400000",
    "number": "1427366871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 706",
            "city": "EVERGREEN",
            "state": "AL",
            "postal_code": "364010706",
            "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": "2010-09-20",
        "last_updated": "2012-03-27",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "SHARON",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "251-578-2480"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "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

Verify at the official NPI Registry.