EVERGREEN ENDOSCOPY CENTER, LLC
NPI 1093974602
Clinic/Center - Ambulatory Surgical in South Windsor, CT

NPI Status: Active since June 09, 2008

Contact Information

2400 TAMARACK AVENUE
SUITE 100
SOUTH WINDSOR, CT
ZIP 06074
Phone: (860) 644-7336

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  • Organization
  • Clinic/Center
  • Ambulatory Surgical
  • CLIA Number: 07D1085306
  • CLIA Cert. Type: Other
  • CLIA Exp. Date: 06-12-2026

About EVERGREEN ENDOSCOPY CENTER, LLC

This page provides the complete NPI Profile along with additional information for Evergreen Endoscopy Center, Llc, a provider established in South Windsor, Connecticut operating as a Clinic/center, focusing in ambulatory surgical . The healthcare provider is registered in the NPI registry with number 1093974602 assigned on June 2008. The practitioner's primary taxonomy code is 261QA1903X. The provider is registered as an organization and their NPI record was last updated 9 years ago. The authorized official of this NPI record is William A Wollman (Executive Director)

NPI
1093974602
Provider Name
EVERGREEN ENDOSCOPY CENTER, LLC
Entity Type
Organization
Location Address
2400 TAMARACK AVENUE SUITE 100 SOUTH WINDSOR, CT 06074
Location Phone
(860) 644-7336
Mailing Address
2400 TAMARACK AVENUE SUITE 100 SOUTH WINDSOR, CT 06074
Mailing Phone
(860) 644-7336
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
06-09-2008
Last Update Date
11-15-2017
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Clinic/Center Ambulatory Surgical

Taxonomy Code
261QA1903X
Type
Ambulatory Health Care Facilities

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No. Taxonomy Code Type Classification /
Specialization
License No. (State)
1261QE0800XAmbulatory Health Care Facilities

Clinic/Center
Endoscopy

 

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

WILLIAM A WOLLMAN

Authorized Official Title
EXECUTIVE DIRECTOR
Authorized Official Phone
(860) 533-2123

Areas of Expertise

The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.

Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope

This procedure involves using a thin, flexible tube with a light and camera, known as an endoscope, to examine the esophagus, stomach, and upper part of the small intestine. Small tissue samples are taken for further examination to help diagnose various conditions.

This service was performed 147 times for 144 patients

Biopsy of large bowel using a flexible endoscope

A biopsy of the large bowel using a flexible endoscope is a procedure where a thin, flexible tube with a camera is inserted through the rectum to examine the bowel. If abnormal tissue is found, a small sample is taken for further examination. This helps in diagnosing conditions like inflammation, polyps, or cancer.

This service was performed 169 times for 167 patients

Colorectal cancer screening; colonoscopy on individual at high risk

Colorectal cancer screening, specifically a colonoscopy, is a preventive measure for those at high risk. A thin, flexible tube with a camera inspects the colon to spot any abnormal growths. This test helps detect potential issues early, enhancing the effectiveness of treatment.

This service was performed 35 times for 35 patients

Diagnostic exam of large bowel using a flexible endoscope

This procedure, known as a colonoscopy, involves using a flexible tube with a light and camera to examine the large intestine. It helps detect any abnormalities such as polyps or inflammation. It's a standard procedure to ensure gut health.

This service was performed 94 times for 93 patients

Dilation of esophagus

Dilation of the esophagus is a procedure aimed to stretch or open up your esophagus (the tube connecting your mouth to your stomach) when it's narrow. It helps to improve swallowing and alleviate discomfort. It's typically performed using a flexible tube or balloon, under sedation.

This service was performed 12 times for 12 patients

Injection of substance into lower spine canal using imaging guidance

This procedure involves injecting a substance into your lower spine canal, guided by real-time images. It's done to diagnose or treat various conditions. You may feel slight discomfort, but it's generally safe and can provide valuable information for your treatment plan.

This service was performed 97 times for 61 patients

Removal of polyps or growths of large bowel using an endoscope with mechanical snare

This procedure involves using a thin, flexible tube called an endoscope to examine the large bowel. If any abnormal growths or polyps are found, a tool called a mechanical snare is used to remove them. This is a common method to prevent potential health issues.

This service was performed 103 times for 102 patients

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
07D1085306
Facility Type
Other
Certificate Effective Date
June 13, 2024
Certificate Expiration Date
June 12, 2026
Laboratory Director
JOSEPH H. IANELLO
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to Evergreen Endoscopy Center, Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

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NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1093974602, we treat the final digit (2) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 68. The final step is to find the difference between that total and the next multiple of ten (70 - 68 = 2).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1
1
Doubled → 2
Pos 2
0
Unchanged
Pos 3
9
Doubled → 18 → 1 + 8
Pos 4
3
Unchanged
Pos 5
9
Doubled → 18 → 1 + 8
Pos 6
7
Unchanged
Pos 7
4
Doubled → 8
Pos 8
6
Unchanged
Pos 9
0
Doubled → 0
Check
2
Target digit
Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 9 → 18 → 9 9 → 18 → 9 4 → 8 0 → 0

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 0 + 1 + 8 + 3 + 1 + 8 + 7 + 8 + 6 + 0 + 24 = 68

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 68 is 70. The difference is the calculated check digit.

70 - 68 = 2
This NPI is valid
The calculated check digit is 2, which matches the last digit of 1093974602.

Other Providers at the Same Location


The following 2 providers are registered at the same or a nearby location.

Psychologist
2400 TAMARACK AVENUE
SOUTH WINDSOR, CT 06074
Psychologist
2400 TAMARACK AVENUE, SUITE 201
SOUTH WINDSOR, CT 06074

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1093974602, enumerated as an "organization" on June 09, 2008.

The provider is located at 2400 TAMARACK AVENUE SUITE 100 SOUTH WINDSOR, CT 06074 and the phone number is (860) 644-7336.

Clinic/Center with taxonomy code 261QA1903X and a focus in Ambulatory Surgical.