NPIMap

Organization Active NPI

Evernorth Care Providers - Delaware PA

  • General Practice Physician
  • Cincinnati, OH
National Provider Identifier
1801670435
Registry record updated Mar 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
EVERNORTH CARE PROVIDERS - DELAWARE PA
Practice address
8044 Montgomery Rd Ste 700
Cincinnati, OH 45236-2926
Phone
(773) 292-4800
Fax
(312) 564-4059
NPI assigned
Aug 23, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2024

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

Authorized official

Name
Grace V Blue
Title
Credentialing Sr. Manager
Phone
(773) 292-4800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

8044 Montgomery Rd Ste 700
Cincinnati, OH 45236-2926

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 OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231214003006 OH Part B Supplier - Clinic/Group Practice 6002217973 Practice locations: Cincinnati, OH

Other NPIs with the same Medicare PAC ID 11

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

National Provider Directory

National Provider Directory

Locations

440 Polaris Pkwy
Westerville, OH 43082

NPI Registry JSON

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

{
    "created_epoch": "1692748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709769600000",
    "number": "1801670435",
    "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": "8044 MONTGOMERY RD STE 700",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452362926",
            "telephone_number": "773-292-4800",
            "fax_number": "312-564-4059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERNORTH CARE PROVIDERS - DELAWARE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-23",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A",
        "authorized_official_last_name": "BLUE",
        "authorized_official_first_name": "GRACE",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "CREDENTIALING SR. MANAGER",
        "authorized_official_telephone_number": "773-292-4800"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; 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.