NPIMap

Organization Active NPI

Evergreen Pediatrics Solutions, PC

  • Pediatrics Physician
  • Montclair, NJ
National Provider Identifier
1700864428
Registry record updated May 27, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
EVERGREEN PEDIATRICS SOLUTIONS, PC
Practice address
1 Bay Ave
Evergreen Pediatric Solutions, PC
Montclair, NJ 07042-4837
Phone
(973) 237-5795
Fax
(919) 425-0478
NPI assigned
Jan 3, 2006
Last updated
May 27, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2009

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

Authorized official

Name
Dr. Steven R Scott, MDNPI 1659377463
Title
President
Phone
(919) 425-1565

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

1 Bay Ave
Evergreen Pediatric Solutions, PC
Montclair, NJ 07042-4837

Mailing address

3114 Croasdaile Dr Ste 200
Evergreen Pediatric Solutions, PC
Durham, NC 27705-2508
Phone (919) 425-1565

Other identifiers 1

IdentifierTypeStateIssuer
0079481MedicaidNJ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1136246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243382400000",
    "number": "1700864428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3114 CROASDAILE DR STE 200",
            "address_2": "EVERGREEN PEDIATRIC SOLUTIONS, PC",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277052508",
            "telephone_number": "919-425-1565",
            "fax_number": "919-425-0478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BAY AVE",
            "address_2": "EVERGREEN PEDIATRIC SOLUTIONS, PC",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070424837",
            "telephone_number": "973-237-5795",
            "fax_number": "919-425-0478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN PEDIATRICS SOLUTIONS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-03",
        "last_updated": "2009-05-27",
        "status": "A",
        "authorized_official_last_name": "SCOTT",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "919-425-1565",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0079481",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Montclair, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.