EVERNORTH CARE PROVIDERS - TENNESSEE PC
NPI 1174304976
General Practice in Fairfax, VA

NPI Status: Active since October 09, 2023

Contact Information

11350 RANDOM HILLS RD STE 800
FAIRFAX, VA
ZIP 22030
Phone: (773) 292-4800
Fax: (312) 564-4059

Recently Updated NPI Information
Some details in this NPI profile have been updated in the NPI registry within the last 30 days.

Table of Contents

NPI Profile Information
Primary Taxonomy
Group Taxonomy
Authorized Official
CLIA Information
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Organization
General Practice
CLIA Number: 49D2300070
CLIA Cert. Type: Other - IN HOME PRIMARY CARE
CLIA Exp. Date: 03-03-2026

About EVERNORTH CARE PROVIDERS - TENNESSEE PC

This page provides the complete NPI Profile along with additional information for Evernorth Care Providers - Tennessee Pc, a primary care provider established in Fairfax, Virginia operating as a General Practice. The healthcare provider is registered in the NPI registry with number 1174304976 assigned on October 2023. The practitioner's primary taxonomy code is 208D00000X. The provider is registered as an organization and their NPI record was last updated July 2025. Evernorth Care Providers - Tennessee Pc operates as a multi-specialty business group with one or more individual providers who practice different areas of specialization. The authorized official of this NPI record is Jacqueline D Lakes (Senior Paralegal)

NPI: 1174304976
Provider Name: EVERNORTH CARE PROVIDERS - TENNESSEE PC
Entity Type: Organization
Location Address: 11350 RANDOM HILLS RD STE 800 FAIRFAX, VA 22030
Location Phone: (773) 292-4800
Location Fax: (312) 564-4059
Mailing Address: 730 COOL SPRINGS BLVD STE 500 FRANKLIN, TN 37067
Mailing Phone: (773) 292-4800
Mailing Fax: (312) 564-4059
Is Sole Proprietor?: No
Is Organization Subpart?: No
Enumeration Date: 10-09-2023
Last Update Date: 07-14-2025
Code Navigator

A primary care provider (PCP) like Evernorth Care Providers - Tennessee Pc sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc .

Location Map

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: General Practice
Taxonomy Code: 208D00000X
Type: Allopathic & Osteopathic Physicians
Taxonomy Description: 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

Group Taxonomy 193200000X MULTI-SPECIALTY GROUP

This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.

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: JACQUELINE D LAKES
Authorized Official Title: SENIOR PARALEGAL
Authorized Official Phone: (954) 446-0640

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: 49D2300070
Facility Type: Other - IN HOME PRIMARY CARE
Certificate Effective Date: March 04, 2024
Certificate Expiration Date: March 03, 2026
Laboratory Director: CHERYL A. HILTON
Certificate Type: Certificate of Waiver
Certificate Type Description: This CLIA certificate is issued to Evernorth Care Providers - Tennessee Pc 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.

NPI Validation Check Digit Calculation

The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1	1	7	4	3	0	4	9	7	6
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2	1	14	4	6	0	8	9	14
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 1 + 1 + 4 + 4 + 6 + 0 + 8 + 9 + 1 + 4 + 24 = 64
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 64 = 6									6

The NPI number 1174304976 is valid because the calculated check digit 6 using the Luhn validation algorithm matches the last digit of the original NPI number.