EVERNORTH CARE PROVIDERS - DELAWARE PA
NPI 1013795053
General Practice in Indianapolis, IN

Q: What is Evernorth Care Providers - Delaware PA's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Active since September 20, 2023CLIA 15D2310439 · Waiver

8888 KEYSTONE XING STE 1300, INDIANAPOLIS, IN 46240(773) 292-4800(312) 564-4059 Get Directions Write a Review

NPPES record last updated: January 24, 2024. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Evernorth Care Providers - Delaware Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EVERNORTH CARE PROVIDERS - DELAWARE PA (NPI 1013795053) is a healthcare organization registered as a general practice in Indianapolis, Indiana and active in the NPI registry since September 2023. The organization holds a CLIA Waiver certificate valid through September 3, 2026 and lists Grace V Blue, Credentialing Sr. Manager, as its authorized official.

NPPES Registry Identity

NPI1013795053

Entity TypeOrganization

Primary Taxonomy208D00000X

Legal Business NameEVERNORTH CARE PROVIDERS - DELAWARE PA

Location Address8888 KEYSTONE XING STE 1300Indianapolis, IN 46240-4600

Mailing Address730 Cool Springs Blvd Ste 500Franklin, TN 37067-7331 · (773) 292-4800 · Fax (312) 564-4059

Phone(773) 292-4800

Fax(312) 564-4059

Organization SubpartNo

Authorized OfficialGrace V BlueCredentialing Sr. Manager · (773) 292-4800

Enumeration DateSeptember 20, 2023

Last NPPES UpdateJanuary 24, 2024

NPPES CertifiedJanuary 24, 2024

✔ NPI 1013795053 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians

Taxonomy Code208D00000X

Definition

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

8888 KEYSTONE XING STE 1300, Indianapolis, IN 46240

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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 15D2310439

Evernorth Care Providers - Delaware PA · Indianapolis, IN

Active · expires Sep 3, 2026

CLIA Number15D2310439

Laboratory TypeIn Home Primary Care

Certificate Effective DateSeptember 4, 2024

Certificate Expiration DateSeptember 3, 2026

Laboratory DirectorShannon Alsop

Laboratory Phone(877) 663-1333

Laboratory LocationEvernorth Care Providers - Delaware PA8888 Keystone Crossing, Suite 1300, Indianapolis, IN 46240

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TAMIKA NICOLE MONTGOMERY LMFT

Marriage & Family Therapist