NPIMap

Organization Active NPI

Evernorth Care Providers - Tennessee PC

  • General Practice Physician
  • Lexington, KY
National Provider Identifier
1831979335
Registry record updated Jul 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
EVERNORTH CARE PROVIDERS - TENNESSEE PC
Practice address
1040 Monarch St FL 3
Lexington, KY 40513-1852
Phone
(773) 292-4800
Fax
(312) 564-4059
NPI assigned
Oct 2, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2025

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

Authorized official

Name
Jacqueline D Lakes
Title
Senior Paralegal
Phone
(954) 446-0640

Specialties & licenses 1

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

Addresses

Primary practice location

1040 Monarch St FL 3
Lexington, KY 40513-1852

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 KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240103000187 KY Part B Supplier - Clinic/Group Practice 7911355532 Receives reassigned benefits from 1 practitioner
Practice locations: Lexington, KY

Other NPIs with the same Medicare PAC ID 9

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

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.

NPI Registry JSON

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

{
    "created_epoch": "1696204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752451200000",
    "number": "1831979335",
    "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": "1040 MONARCH ST FL 3",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405131852",
            "telephone_number": "773-292-4800",
            "fax_number": "312-564-4059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERNORTH CARE PROVIDERS - TENNESSEE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-02",
        "last_updated": "2025-07-14",
        "certification_date": "2025-07-14",
        "status": "A",
        "authorized_official_last_name": "LAKES",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "SENIOR PARALEGAL",
        "authorized_official_telephone_number": "954-446-0640"
    },
    "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 Lexington, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2025; 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.