Evergreen Primary Care PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

EVERGREEN PRIMARY CARE PLLC

Practice address

1337 Wilderness Run Dr
Eagan, MN 55123-1856

Phone

(612) 817-7240

NPI assigned

Jun 23, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Shary Vang, MDNPI 1619116282

Title

Member

Phone

(612) 817-7240

Specialties & licenses 2

Addresses

Practitioners 1

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

• Shary Vang, MD

  • Internal Medicine Physician
  • Saint Paul, MN
  • NPI 1619116282
  NPD Authorized official

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

{
    "created_epoch": "1624406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624406400000",
    "number": "1831768704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1337 WILDERNESS RUN DR",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551231856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1337 WILDERNESS RUN DR",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551231856",
            "telephone_number": "612-817-7240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN PRIMARY CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-23",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A",
        "authorized_official_last_name": "VANG",
        "authorized_official_first_name": "SHARY",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "612-817-7240",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Eagan, MN
• Providers in Eagan, MN by specialty
• Internal Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2021; 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.