Individual provider Active NPI

Edward Theodore Evans, M.D.

  • Diagnostic Ultrasound Physician
  • Santa Rosa, CA
National Provider Identifier
1144319039
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Ultrasound PhysicianTaxonomy code 2085U0001X
License
A22103 Issued in CA
Practice address
121 Sotoyome St
Santa Rosa, CA 95405-4823
Phone
(707) 546-4062
Fax
(707) 578-6258
NPI assigned
Oct 11, 2006
Last updated
Sep 11, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging Physician 2085B0100X A22103 CA
Nuclear Radiology Physician 2085N0904X A22103 CA
Diagnostic Radiology Physician 2085R0202X A22103 CA
Diagnostic Ultrasound Physician 2085U0001X A22103 CA Primary

Addresses

Primary practice location

121 Sotoyome St
Santa Rosa, CA 95405-4823

Mailing address

121 Sotoyome St
Santa Rosa, CA 95405-4823
Phone (707) 546-4062

Other identifiers 1

IdentifierTypeStateIssuer
00A221030MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A22103CAMDDiagnostic Ultrasound Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Redwood Regional Medical Group Inc Diagnostic Radiology Past Accepting new patients
Redwood Regional Medical Group, Inc. Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1144319039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 SOTOYOME ST",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054823",
            "telephone_number": "707-546-4062",
            "fax_number": "707-578-6258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 SOTOYOME ST",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054823",
            "telephone_number": "707-546-4062",
            "fax_number": "707-578-6258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "EDWARD",
        "middle_name": "THEODORE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "CA",
            "license": "A22103",
            "primary": false
        },
        {
            "code": "2085N0904X",
            "taxonomy_group": "",
            "desc": "Radiology, Nuclear Radiology",
            "state": "CA",
            "license": "A22103",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A22103",
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "CA",
            "license": "A22103",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A221030",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.