NPIMap

Organization Active NPI

Evergreen Care Center LTD

  • General Practice Physician
  • Evergreen Park, IL
National Provider Identifier
1447449616
Registry record updated Apr 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
EVERGREEN CARE CENTER LTD
Practice address
9760 S Kedzie Ave
Suite 3
Evergreen Park, IL 60805-3109
Phone
(708) 423-6209
Fax
(708) 423-9021
NPI assigned
Oct 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2025

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

Authorized official

Name
Dr. George Thomas, MDNPI 1073746046
Title
Owner
Phone
(708) 423-6209

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

9760 S Kedzie Ave
Suite 3
Evergreen Park, IL 60805-3109

Mailing address

9760 S Kedzie Ave
Suite 3
Evergreen Park, IL 60805-3109
Phone (708) 423-6209

Other identifiers 2

IdentifierTypeStateIssuer
036084895MedicaidIL
DA0131OtherILRAIL ROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040218000589 IL Part B Supplier - Clinic/Group Practice 2163317124 Receives reassigned benefits from 12 practitioners
Practice locations: Evergreen Park, IL

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
14D1018526Evergreen Care Center LTD9760 S Kedzie Ave-Suite 3, Evergreen Park, IL 60805Certificate of waiverOct 23, 2027

National Provider Directory

National Provider Directory

Locations

9760 S Kedzie Ave
Ste 3
Evergreen Pk, IL 60805
Phone (708) 423-6209

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1193097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745884800000",
    "number": "1447449616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9760 S KEDZIE AVE",
            "address_2": "SUITE 3",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608053109",
            "telephone_number": "708-423-6209",
            "fax_number": "708-423-9021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9760 S KEDZIE AVE",
            "address_2": "SUITE 3",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608053109",
            "telephone_number": "708-423-6209",
            "fax_number": "708-423-9021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN CARE CENTER LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-23",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-29",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-423-6209",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036084895",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "DA0131",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evergreen Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.