EVERGREEN PEDIATRICS INC (NPI# 1972641736) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972641736 |
| Entity Type | Organization |
| Organization Name | EVERGREEN PEDIATRICS INC |
| Practice Address |
4205 San Felipe Rd #110 San Jose CA 95135-1503 |
| Practice Telephone | 4082388303 |
| Practice Fax Number | 4082388375 |
| Mailing Telephone | 4082388303 |
| Mailing Fax Number | 4082388375 |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2013-10-02 |
| Authorized Official Name | DR. PRONOTI NIGAM (PHYSICIAN) |
| Authorized Official Telephone | 4082388303 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | A33613 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00C431251 | 05 | |
| CA | ZAHIDA P MALIKMD NPI | 1750497608 | 01 |
| CA | BLUE CROSS MEDICAL | R09208 | 01 |
| CA | 00A336130 | 05 | |
| BLUE CROSS MEDICAL | R09238 | 01 | |
| CA | PRONOTI NIGAM MD NPI | 1053390310 | 01 |
| Street Address |
4205 SAN FELIPE RD #110 |
| City | SAN JOSE |
| State | CA |
| Zip Code | 95135-1503 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053390310 | Pronoti Nigam | Pediatrics | 4205 San Felipe Rd, Suite 110, San Jose, CA 95135-1503 | 2006-01-13 |
| 1609493378 | Maria Picariello | Dentist | 4205 San Felipe Rd, San Jose, CA 95135-1503 | 2020-06-29 |
| 1467815092 | Anthony Dinh | Physical Therapist | 4205 San Felipe Rd, San Jose, CA 95135-1503 | 2016-03-31 |
| 1013377035 | Nguyen Khoi Tran Do | Physical Therapist | 4205 San Felipe Rd, Ste 100, San Jose, CA 95135-1503 | 2016-03-03 |
| 1477911881 | Meiying Lam | Physical Therapist | 4205 San Felipe Rd, Ste 100, San Jose, CA 95135-1503 | 2016-02-01 |
| 1073902706 | Amanda Justine Carrillo | Physical Therapist | 4205 San Felipe Rd, Suite 100, San Jose, CA 95135-1503 | 2015-01-19 |
| 1346662913 | Matthew Guthrie | Physical Therapist | 4205 San Felipe Rd, Ste 100, San Jose, CA 95135-1503 | 2014-01-15 |
| 1003188624 | Robert Myles Noakes | Physical Therapist | 4205 San Felipe Rd, Suite 100, San Jose, CA 95135-1503 | 2012-01-27 |
| 1689960809 | Douglas W. Vierra, D.d.s., Inc. | Dentist | 4205 San Felipe Rd, Suite 200, San Jose, CA 95135-1505 | 2011-06-27 |
| 1154485142 | Sharon Diana Hoefling | Dentist | 4205 San Felipe Rd, Suite 200, San Jose, CA 95135 | 2006-12-21 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285199497 | Dharitri Pattanaik | Respiratory Therapist, Registered | 2919 Queens Estates Ct, San Jose, CA 95135 | 2019-02-01 |
| 1184170458 | Excel Medicine Inc | General Acute Care Hospital | 4035 Evergreen Village Square, St # 60, San Jose, CA 95135 | 2016-08-28 |
| 1205106770 | Angel Prestige Residential Care, LLC | Custodial Care Facility | 3305 Marcel Court, San Jose, CA 95135 | 2011-12-30 |
| 1427182179 | Andrew D Harsany Dds Inc | Dentist | 2945 The Villages Parkway, San Jose, CA 95135 | 2007-03-15 |
| 1548377898 | Berna Sanayei | Dentist | 2929 The Villages Parkway, San Jose, CA 95135 | 2006-08-24 |
| 1821034232 | Anupama Balakrishnan | Family Medicine | 1333 Meridian Avenue, San Jose, CA 95135 | 2006-06-22 |
| 1679889869 | Binh Bao Lam | Dentist | 3869 Thompson Creek Ct, San Jose, CA 95135-1000 | 2010-08-25 |
| 1780187666 | Edna Porter Lewis | Counselor | 4078 Lawther Ct, San Jose, CA 95135-1021 | 2018-03-16 |
| 1346708310 | Atin Gupta | Physical Therapist | 4205 Ruby Ave, San Jose, CA 95135-1109 | 2019-03-07 |
| 1760708911 | Roberto J Sepulveda | Dentist | 3172 Linkfield Way, San Jose, CA 95135-1116 | 2010-04-13 |
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| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013424217 | Bay Area Pediatric Primary Care Inc. | Pediatrics | 244 N Jackson Ave Ste 203, San Jose, CA 95116-1604 | 2018-01-09 |
| 1912399478 | Myron Lee Stone | Pediatrics | 2101 Forest Ave Ste 130, San Jose, CA 95128-1424 | 2015-02-20 |
| 1205243763 | George Shin Han | Pediatrics | 976 Lenzen Ave Ste 1100, San Jose, CA 95126-2737 | 2014-07-16 |
| 1033537006 | Sphoorti D. Umarjee | Pediatrics | 276 International Cir Fl 1, San Jose, CA 95119-1130 | 2014-04-06 |
| 1508209453 | Richard Anthony Cirone Sr. | Pediatrics | 1645 Peregrino Way, San Jose, CA 95125-4547 | 2013-04-10 |
| 1679812556 | Hien Van Nguyen | Pediatrics | 1675 Burdette Dr, Ste #20, San Jose, CA 95121 | 2013-02-12 |
| 1699034199 | Amina Ahmed | Pediatrics | 2577 Samaritan Dr Ste 830, San Jose, CA 95124-4109 | 2012-05-04 |
| 1801166442 | Catherine S Yao | Pediatrics | 750 South Bascom Avenue, San Jose, CA 95128 | 2012-01-12 |
| 1659677243 | Sundus Ali | Pediatrics | 6489 Camden Ave Ste 102, San Jose, CA 95120 | 2011-01-31 |
| 1134459852 | Priyansha Sen Jamwal | Pediatrics | 80 Descanso Dr Unit 1317, San Jose, CA 95134-1829 | 2009-12-31 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.