Evergreen Family Medical Services,P.C.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

EVERGREEN FAMILY MEDICAL SERVICES,P.C.

Practice address

743 58TH St
Brooklyn, NY 11220-3916

Phone

(718) 765-0088

Fax

(718) 567-8208

NPI assigned

Feb 26, 2006

Organization subpart

No

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

Authorized official

Name

Raymond Chan, MDNPI 1477741981

Title

Medical Diretor

Phone

(718) 765-0088

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 5

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

• Raymond Chan, MD

  • Family Medicine Physician
  • Brooklyn, NY
  • NPI 1477741981
  Medicare reassignment Authorized official
• Melissa Chan, MD

  • Internal Medicine Physician
  • New York, NY
  • NPI 1922681626
  Medicare reassignment NPD
• Stanley Chan, MD

  • Internal Medicine Physician
  • Brooklyn, NY
  • NPI 1295210763
  Medicare reassignment NPD
• Xiaoyu Sylvia Li, D.O.

  • Student in an Organized Health Care Education/Training Program
  • Southampton, NY
  • NPI 1205275799
  Medicare reassignment NPD
• Sally Wen, MD

  • Internal Medicine Physician
  • Brooklyn, NY
  • NPI 1063156669
  Medicare reassignment NPD

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

{
    "created_epoch": "1140912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349049600000",
    "number": "1891761243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "743 58TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112203916",
            "telephone_number": "718-765-0088",
            "fax_number": "718-567-8208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "743 58TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112203916",
            "telephone_number": "718-765-0088",
            "fax_number": "718-567-8208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN FAMILY MEDICAL SERVICES,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-26",
        "last_updated": "2012-10-01",
        "status": "A",
        "authorized_official_last_name": "CHAN",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_title_or_position": "MEDICAL DIRETOR",
        "authorized_official_telephone_number": "718-765-0088",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02720354",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Everest Medical, P.C.
• Everest Podiatry PLLC
• Alexandra Everett, LCSW
• Evergreen Boro Park Comprehensive Medicine PLLC
• Evergreen DME, Inc.
• Evergreen Gables Physical Therapy PC
• Evergreen Medical PLLC
• Evergreen Pharmacy Inc
• Evergreen Senior Daycare Center
• Evergreen Senior Daycare Center Inc

• Family Medicine Physician in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.