Evernorth Care Providers - Arizona PC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

EVERNORTH CARE PROVIDERS - ARIZONA PC

Practice address

2850 W Horizon Ridge Pkwy Ste 200
Henderson, NV 89052-4395

Phone

(773) 292-4800

Fax

(312) 564-4059

NPI assigned

Jan 8, 2024

Last updated

Jan 8, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Grace Blue

Title

Credentialing Sr. Manager

Phone

(773) 292-4800

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NV

Enrollment records 1

Other NPIs with the same Medicare PAC ID 2

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

• Evernorth Care Providers - Arizona PC

  • General Practice Physician
  • Seattle, WA
  • NPI 1417731035

  6002268455

  Same PAC ID
• Evernorth Care Providers - Arizona PC

  • General Practice Physician
  • Scottsdale, AZ
  • NPI 1922786946

  6002268455

  Same PAC ID

Practitioners 1

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.

• Cheryl A Hilton, D.O.

  • Internal Medicine Physician
  • Nashville, TN
  • NPI 1184677742
  NPD

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

{
    "created_epoch": "1704672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704672000000",
    "number": "1891565123",
    "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": "2850 W HORIZON RIDGE PKWY STE 200",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890524395",
            "telephone_number": "773-292-4800",
            "fax_number": "312-564-4059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERNORTH CARE PROVIDERS - ARIZONA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-08",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "status": "A",
        "authorized_official_last_name": "BLUE",
        "authorized_official_first_name": "GRACE",
        "authorized_official_title_or_position": "CREDENTIALING SR. MANAGER",
        "authorized_official_telephone_number": "773-292-4800"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sheila Marie Farrales Evaristo, APRN
• Svetlana Eveleigh, APRN
• Amber Ashley Judith Evelyn
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• Everside Health LLC (Union Family Health Center Purple)
• Everside Health LLC (Teamsters Local 14 with MH Family WC Yellow)
• Everside Health Local 14 Henderson Dispensing
• Everside Health, LLC
• Everside Health, LLC (Teamsters Local 14 with Marathon Health Family Wellness Center - Henderson)

• General Practice Physician in Henderson, NV
• Providers in Henderson, NV by specialty
• General Practice Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 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.