NPIMap

Organization Active NPI

Evergreen Medical Center LLC

Doing business as Nicole M Laird CRNP

  • Internal Medicine Physician
  • Evergreen, AL
National Provider Identifier
1891904223
Registry record updated Apr 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
H1801 Issued in AL
Legal business name
EVERGREEN MEDICAL CENTER LLC
Doing business as
Nicole M Laird CRNP
Practice address
106 Edwina St
Evergreen, AL 36401-3319
Phone
(251) 578-4300
Fax
(251) 578-4307
NPI assigned
May 22, 2007
Last updated
Apr 20, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
EVERGREEN MEDICAL CENTER LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 20, 2010

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

Authorized official

Name
Mrs. Sharon Jones
Title
Chief Financial Officer
Phone
(251) 578-2480

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 19723 AL
Internal Medicine Physician 207R00000X H1801 AL Primary

Addresses

Primary practice location

106 Edwina St
Evergreen, AL 36401-3319

Mailing address

106 Edwina St
Evergreen, AL 36401-3319
Phone (251) 578-4300

Other identifiers 3

IdentifierTypeStateIssuer
529933018OtherALMEDICAID PAYEE
529906180OtherALMEDICAID GROUP PAYEE NUMB
510G700111OtherALMEDICARE PTAN

Other names 1

  • Nicole M Laird CRNP Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080310000628 AL Part B Supplier - Clinic/Group Practice 6305942145 Receives reassigned benefits from 7 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Evergreen, AL

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Evergreen Medical Center LLC4 organizations share this tax ID, including this one
Part of
Evergreen Medical Center LLC

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

106 Edwina St
Evergreen, AL 36401
Phone (251) 578-4300

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271721600000",
    "number": "1891904223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 EDWINA ST",
            "city": "EVERGREEN",
            "state": "AL",
            "postal_code": "364013319",
            "telephone_number": "251-578-4300",
            "fax_number": "251-578-4307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 EDWINA ST",
            "city": "EVERGREEN",
            "state": "AL",
            "postal_code": "364013319",
            "telephone_number": "251-578-4300",
            "fax_number": "251-578-4307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN MEDICAL CENTER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EVERGREEN MEDICAL CENTER LLC",
        "enumeration_date": "2007-05-22",
        "last_updated": "2010-04-20",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "SHARON",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "251-578-2480",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "19723",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "H1801",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID PAYEE",
            "identifier": "529933018",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID GROUP PAYEE NUMB",
            "identifier": "529906180",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "510G700111",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nicole M Laird CRNP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Evergreen, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2010; 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.