NPIMap

Organization Active NPI

Evergreen Surgical, S.C.

  • Surgery Physician
  • Eau Claire, WI
National Provider Identifier
1740238872
Registry record updated Jul 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
EVERGREEN SURGICAL, S.C.
Practice address
719 W Hamilton Ave
Suite C
Eau Claire, WI 54701-6968
Phone
(715) 832-1044
Fax
(715) 832-0520
NPI assigned
May 4, 2006
Last updated
Jul 23, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2021

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

Authorized official

Name
Steven C. Immerman, M.D.NPI 1740241538
Title
President
Phone
(715) 832-1044

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
Surgery Physician 208600000X Primary

Addresses

Primary practice location

719 W Hamilton Ave
Suite C
Eau Claire, WI 54701-6968

Mailing address

719 W Hamilton Ave
Suite C
Eau Claire, WI 54701-6968
Phone (715) 832-1044

Other identifiers 1

IdentifierTypeStateIssuer
32865800MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081024000456 WI Part B Supplier - Clinic/Group Practice 8325106040 Receives reassigned benefits from 7 practitioners
Practice locations: Chippewa Falls, WI; Durand, WI; Eau Claire, WI; Stanley, WI

National Provider Directory

National Provider Directory

Locations

719 W Hamilton Ave
Ste C
Eau Claire, WI 54701
Phone (715) 832-1044

Practitioners & affiliated clinicians

Practitioners 9

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": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626998400000",
    "number": "1740238872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "719 W HAMILTON AVE",
            "address_2": "SUITE C",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547016968",
            "telephone_number": "715-832-1044",
            "fax_number": "715-832-0520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 W HAMILTON AVE",
            "address_2": "SUITE C",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547016968",
            "telephone_number": "715-832-1044",
            "fax_number": "715-832-0520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN SURGICAL, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-04",
        "last_updated": "2021-07-23",
        "certification_date": "2021-07-23",
        "status": "A",
        "authorized_official_last_name": "IMMERMAN",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "715-832-1044",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32865800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eau Claire, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 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.