Evergreen Therapy Services-LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

EVERGREEN THERAPY SERVICES-LLC

Practice address

1819 11TH St
Great Bend, KS 67530-4511

Phone

(785) 483-9183

NPI assigned

Jun 12, 2021

Organization subpart

No

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

Authorized official

Name

Pamela M Middleton, LSCSWNPI 1457702912

Title

Clinical Social Worker

Phone

(785) 483-9183

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KS

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Pamela M Middleton, LSCSW

  • Clinical Social Worker
  • Great Bend, KS
  • NPI 1457702912
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1623456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627948800000",
    "number": "1720656135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1819 11TH ST",
            "city": "GREAT BEND",
            "state": "KS",
            "postal_code": "675304511",
            "telephone_number": "785-483-9183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1819 11TH ST",
            "city": "GREAT BEND",
            "state": "KS",
            "postal_code": "675304511",
            "telephone_number": "785-483-9183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN THERAPY SERVICES-LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-12",
        "last_updated": "2021-08-03",
        "certification_date": "2021-08-03",
        "status": "A",
        "authorized_official_last_name": "MIDDLETON",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "785-483-9183",
        "authorized_official_credential": "LSCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Julianna Facio
• Danielle Rose Fahrney
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• Jan Farmer, RPH

• Clinical Social Worker in Great Bend, KS
• Providers in Great Bend, KS by specialty
• Clinical Social Worker in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2021; 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.