1. Home
  2. Directory
  3. Illinois
  4. Evergreen Park
  5. General Practice
  6. NPI Profile

EVERGREEN CARE CENTER LTD
NPI 1447449616
General Practice in Evergreen Park, IL

Active since October 23, 2007CLIA 14D1018526 · Waiver
9760 S KEDZIE AVE, SUITE 3, EVERGREEN PARK, IL 60805(708) 423-6209(708) 423-9021 Get Directions Write a Review

NPPES record last updated: April 29, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Evergreen Care Center Ltd NPPES

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

EVERGREEN CARE CENTER LTD (NPI 1447449616) is a healthcare organization registered as a general practice in Evergreen Park, Illinois and active in the NPI registry since October 2007. The organization holds a CLIA Waiver certificate valid through October 23, 2027 and lists George Thomas, Owner, as its authorized official.

NPPES Registry Identity

NPI1447449616
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NameEVERGREEN CARE CENTER LTD
Location Address9760 S KEDZIE AVE, SUITE 3Evergreen Park, IL 60805-3109
Mailing Address9760 S Kedzie Ave, Suite 3Evergreen Park, IL 60805-3109 · (708) 423-6209 · Fax (708) 423-9021
Phone(708) 423-6209
Fax(708) 423-9021
Organization SubpartNo
Authorized OfficialGeorge ThomasOwner · (708) 423-6209
Enumeration DateOctober 23, 2007
Last NPPES UpdateApril 29, 2025
NPPES CertifiedApril 29, 2025
✔ NPI 1447449616 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
9760 S KEDZIE AVE, Evergreen Park, IL 60805
Open in Google Maps ↗

Other Identifiers 2

Medicaid036084895IL
OtherDA0131IL · Rail Road Medicare

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Evergreen Care Center Ltd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

5

Medicare enrollment records show 5 clinicians reassign Medicare billing to Evergreen Care Center Ltd, which bills Medicare for the services they deliver. Of these, 4 practice at this address. They are listed nearest first.

Clinicians, nearest first (5)

Keri Brach, APRN
Nurse Practitioner
NPI 1437942448
9760 S KEDZIE AVE STE 3
Evergreen Park, IL 60805
(708) 423-6209
✔ PECOSSame address
Kristina Johnson, D.O.
Family Practice
NPI 1841587334
9760 S KEDZIE AVE STE 2
Evergreen Park, IL 60805
(708) 423-8150
✔ PECOS✔ Accepts MedicareSame address
Thomas Joseph, M.D.
Internal Medicine
NPI 1306836663
9760 S KEDZIE AVE SUITE 2
Evergreen Park, IL 60805
(708) 423-6209
✔ PECOSSame address
George Thomas, M.D.
Family Practice
NPI 1073746046
9760 S KEDZIE AVE SUITE 2
Evergreen Park, IL 60805
(708) 423-8150
✔ PECOS✔ Accepts MedicareSame address
Shefali Shah, MD
Family Practice
NPI 1609815414
2623 N HALSTED ST
Chicago, IL 60614
(773) 929-7410
✔ PECOS✔ Accepts Medicare15 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 14D1018526

Evergreen Care Center Ltd · Evergreen Park, IL
Active · expires Oct 23, 2027
CLIA Number14D1018526
Laboratory TypePhysician Office
Certificate Effective DateOctober 24, 2025
Certificate Expiration DateOctober 23, 2027
Laboratory DirectorThomas Joseph
Laboratory Phone(708) 423-6209
Laboratory LocationEvergreen Care Center Ltd9760 S Kedzie Ave-Suite 3, Evergreen Park, IL 60805
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Evergreen Care Center Ltd's NPI number?

The NPI number for Evergreen Care Center Ltd is 1447449616. It was assigned to this organization in the NPPES registry on October 23, 2007.

Where is Evergreen Care Center Ltd located?

Evergreen Care Center Ltd is located at 9760 S Kedzie Ave Suite 3, Evergreen Park, IL 60805. The listed phone number is (708) 423-6209.

What is Evergreen Care Center Ltd's specialty?

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

Is Evergreen Care Center Ltd enrolled in Medicare?

Yes. Evergreen Care Center Ltd is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Evergreen Care Center Ltd?

According to the CMS Revalidation Reassignment List (October 2026 release), 5 clinicians in 3 Medicare specialties reassign their Medicare billing to Evergreen Care Center Ltd. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Family Practice (3), Internal Medicine (1) and Nurse Practitioner (1). Of these, 4 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Evergreen Care Center Ltd hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D1018526) is associated with this NPI, valid through October 23, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Evergreen Care Center Ltd was last updated on April 29, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.