NPIMap

Organization Active NPI

Evernorth Care Providers - Tennessee PC

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Ridgeland, MS
National Provider Identifier
1619650041
Registry record updated Jul 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Internal Medicine) PhysicianTaxonomy code 207RH0002X
Legal business name
EVERNORTH CARE PROVIDERS - TENNESSEE PC
Practice address
1000 Highland Colony Pkwy Ste 5203
Ridgeland, MS 39157-2079
Phone
(773) 292-4800
Fax
(312) 564-4059
NPI assigned
Aug 11, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2025

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

Authorized official

Name
Jacqueline D Lakes
Title
Senior Paralegal
Phone
(954) 446-0640

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospice and Palliative Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RH0002X Primary

Addresses

Primary practice location

1000 Highland Colony Pkwy Ste 5203
Ridgeland, MS 39157-2079

Mailing address

730 Cool Springs Blvd Ste 500
Franklin, TN 37067-7331
Phone (773) 292-4800

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231211000481 MS Part B Supplier - Clinic/Group Practice 7911355532 Receives reassigned benefits from 1 practitioner
Practice locations: Ridgeland, MS

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory
Tax ID family
Evernorth Care Providers - Tennessee PC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

22 Millbranch Rd
Ste 800
Hattiesburg, MS 39402

Practitioners & affiliated clinicians

Practitioners 1

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": "1691712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752451200000",
    "number": "1619650041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "730 COOL SPRINGS BLVD STE 500",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370677331",
            "telephone_number": "773-292-4800",
            "fax_number": "312-564-4059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 HIGHLAND COLONY PKWY STE 5203",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391572079",
            "telephone_number": "773-292-4800",
            "fax_number": "312-564-4059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERNORTH CARE PROVIDERS - TENNESSEE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-11",
        "last_updated": "2025-07-14",
        "certification_date": "2025-07-14",
        "status": "A",
        "authorized_official_last_name": "LAKES",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "SENIOR PARALEGAL",
        "authorized_official_telephone_number": "954-446-0640"
    },
    "taxonomies": [
        {
            "code": "207RH0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridgeland, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2025; 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.