Evernorth Care Providers - New Jersey PC
NPI 1174874200ActiveOrganization· General Practice· Totowa, NJ
General Practice in Totowa, New Jersey, registered in NPPES in September 2012. The authorized official on file is Jacqueline D. Lakes, Senior Paralegal.
Overview
| NPI | 1174874200 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Sep 28, 2012 |
| Last updated in NPPES | Jul 14, 2025 |
| Certified by provider | Jul 14, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| General Practice Primary | 208D00000X | — | — |
| Family Medicine | 207Q00000X | — | NJ |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 4, 2026 | No match | — |
| New York OMIG · Nov 4, 2026 | No match | — |
| Ohio Medicaid · Nov 4, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 4, 2026 | No match | — |
| Washington HCA · Nov 4, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
Other General Practice providers in Totowa
- 1225225394
- 1962441873