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EVOLVE 865
NPI 1760189443
Clinic/Center in Lenoir City, TN

Active since February 13, 2023CLIA 44D2282299 · Waiver
460 MEDICAL PARK DR STE 102, LENOIR CITY, TN 37772(865) 384-4865 Get Directions Write a Review

NPPES record last updated: February 13, 2023. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Evolve 865 NPPES

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

EVOLVE 865 (NPI 1760189443) is a healthcare organization registered as a clinic/center in Lenoir City, Tennessee and active in the NPI registry since February 2023. The organization holds a CLIA Waiver certificate valid through May 18, 2027 and lists Jill Dyvon Larson, Owner/np, as its authorized official.

NPPES Registry Identity

NPI1760189443
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business NameEVOLVE 865
Location Address460 MEDICAL PARK DR STE 102Lenoir City, TN 37772-6469
Mailing Address244 Warren Cove Ln Ste 102Lenoir City, TN 37772-3986 · (865) 384-4865
Phone(865) 384-4865
Organization SubpartNo
Authorized OfficialJill Dyvon LarsonOwner/np · (865) 384-4865
Enumeration DateFebruary 13, 2023
NPPES CertifiedFebruary 13, 2023
✔ NPI 1760189443 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities
Taxonomy Code261Q00000X
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
460 MEDICAL PARK DR STE 102, Lenoir City, TN 37772
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Evolve 865 is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Evolve 865, which bills Medicare for the services this clinician delivers.

Clinician (1)

Jill Larson, APN
Nurse Practitioner
NPI 1477678696
3118 ALCOA HWY
Knoxville, TN 37920
(865) 314-7125
✔ PECOS✔ Accepts Medicare19 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 44D2282299

Evolve 865 · Lenoir City, TN
Active · expires May 18, 2027
CLIA Number44D2282299
Laboratory TypePhysician Office
Certificate Effective DateMay 19, 2025
Certificate Expiration DateMay 18, 2027
Laboratory DirectorJill D. Larson
Laboratory Phone(865) 816-3617
Laboratory LocationEvolve 865460 Medical Park Dr Ste 102, Lenoir City, TN 37772
CLIA data matches this NPI record on: Address Name
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 Evolve 865's NPI number?

The NPI number for Evolve 865 is 1760189443. It was assigned to this organization in the NPPES registry on February 13, 2023.

Where is Evolve 865 located?

Evolve 865 is located at 460 Medical Park Dr Ste 102, Lenoir City, TN 37772. The listed phone number is (865) 384-4865.

What is Evolve 865's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Is Evolve 865 enrolled in Medicare?

Yes. Evolve 865 is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Evolve 865?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Evolve 865. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Evolve 865 hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 44D2282299) is associated with this NPI, valid through May 18, 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 Evolve 865 was last updated on February 13, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years 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.