| Evolution Healthcare Management LLC | |
|
7615 E Baseline Rd Suite 101 Mesa AZ 85209-8520 | |
| (480) 354-7878 | |
| Not Available |
| Full Name | Evolution Healthcare Management LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 7615 E Baseline Rd, Mesa, Arizona |
| Authorized Official Name and Position | Fawn Michelle Boonstra (PRESIDENT, MANAGER) |
| Authorized Official Contact | 4802867907 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Evolution Healthcare Management LLC 99 S Gold Dr Ste 6 Apache Junction AZ 85120-5036 Ph: (480) 354-7878 | Evolution Healthcare Management LLC 7615 E Baseline Rd Suite 101 Mesa AZ 85209-8520 Ph: (480) 354-7878 |
| NPI Number | 1770951980 |
|---|---|
| Provider Enumeration Date | 09/03/2015 |
| Last Update Date | 09/12/2025 |
| Certification Date | 04/12/2024 |
| Medicare PECOS PAC ID | 0042571580 |
|---|---|
| Medicare Enrollment ID | O20180226002341 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770951980 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (Arizona) | Primary |
| Provider Name | Shantha S Kumar |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1396768958 PECOS PAC ID: 1557259082 Enrollment ID: I20040426001534 |
| Provider Name | Steven Joel King |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1629069083 PECOS PAC ID: 2668400888 Enrollment ID: I20050729000299 |
| Provider Name | Rachael L Buckley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215479829 PECOS PAC ID: 0042591455 Enrollment ID: I20161223000333 |
| Provider Name | Shiny Susan Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558916247 PECOS PAC ID: 2163752163 Enrollment ID: I20190917003738 |
| Provider Name | Ruth Kendra Rivera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871981076 PECOS PAC ID: 8527383348 Enrollment ID: I20191003003726 |
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