Individual provider Active NPI

Evanna Lerouge

  • Hospice and Palliative Medicine (Emergency Medicine) Physician
  • New York, NY
National Provider Identifier
1558945980
Registry record updated Aug 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Emergency Medicine) PhysicianTaxonomy code 207PH0002X
License
336021 Issued in NY
Practice address
100 E 77TH St
New York, NY 10075-1850
Phone
(212) 434-2000
NPI assigned
May 11, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 125.077942 IL
Hospice and Palliative Medicine (Emergency Medicine) Physician 207PH0002X 336021 NY Primary

Addresses

Primary practice location

100 E 77TH St
New York, NY 10075-1850

Mailing address

100 E 77TH St
New York, NY 10075-1850

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251031004033 NY Practitioner - Emergency Medicine 2961801980 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
State University of New York Downstate Medical Center, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Practice addresses (Care Compare)

900 Franklin Ave
Valley Stream, NY 11580-2145
Phone (516) 256-6000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
336021NYMDLicensed Practical Nurse
125.077942ILMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore - Lij Medical PC CurrentSince Oct 15, 2025 Accepting new patients
North Shore-Lij Medical PC Emergency Medicine CurrentSince Oct 15, 2025 Accepting new patients

Locations

100 E 77th St
New York, NY 10075
Phone (212) 434-2606

300 Community Dr
Plandome, NY 11030

900 Franklin Ave
Valley Stream, NY 11580
Phone (516) 256-6000

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678

Interoperability endpoints

  • Direct secure messaging: elerouge377650@northwell.direct-ci.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1620691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785888000000",
    "number": "1558945980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E 77TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100751850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E 77TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100751850",
            "telephone_number": "212-434-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEROUGE",
        "first_name": "EVANNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-11",
        "last_updated": "2026-08-05",
        "certification_date": "2026-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "125.077942",
            "primary": false
        },
        {
            "code": "207PH0002X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Hospice and Palliative Medicine",
            "state": "NY",
            "license": "336021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.