Evolve Restorative Center

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

Legal business name

EVOLVE RESTORATIVE CENTER

Practice address

220 Concourse Blvd
Santa Rosa, CA 95403-8210

Phone

(844) 527-7369

Fax

(844) 847-4943

NPI assigned

Feb 16, 2018

Organization subpart

No

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

Authorized official

Name

Eric Bruntlett

Title

Coo

Phone

(707) 495-9632

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Linda Anna Dashiell, FNP-C CNM

  • Family Nurse Practitioner
  • Lakeport, CA
  • NPI 1699777508
  Medicare reassignment Care Compare group NPD
• Ramneek Dhillon, MD, MSC

  • Pain Medicine (Anesthesiology) Physician
  • Santa Rosa, CA
  • NPI 1285261974
  Medicare reassignment Care Compare group NPD
• Jeremy Wayne Fuller, NP-C

  • Family Nurse Practitioner
  • Santa Rosa, CA
  • NPI 1285221440
  Medicare reassignment Care Compare group NPD
• Julie K Landecker, DPT

  • Physical Therapist
  • Santa Rosa, CA
  • NPI 1780647693
  Medicare reassignment Care Compare group NPD
• Jason Edward Pope, MD

  • Pain Medicine (Anesthesiology) Physician
  • Santa Rosa, CA
  • NPI 1215078647
  Medicare reassignment Care Compare group NPD
• Anal A Shah, DPT

  • Orthopedic Physical Therapist
  • Santa Rosa, CA
  • NPI 1669920203
  Medicare reassignment Care Compare group NPD
• Chau My Vu, MD

  • Interventional Pain Medicine Physician
  • Pasadena, CA
  • NPI 1538508841

  Anesthesiology

  Medicare reassignment Care Compare group NPD
• Anna Yemiz Mitsunaga, PT DPT

  • Physical Medicine & Rehabilitation Physician
  • Santa Rosa, CA
  • NPI 1851506547
  Medicare reassignment Care Compare group
• Caroline Suzanne Barichievich, MS, PT

  • Physical Therapist
  • Santa Rosa, CA
  • NPI 1679638662
  Medicare reassignment NPD
• Julie Barlow, ACNP-BC

  • Acute Care Nurse Practitioner
  • Santa Rosa, CA
  • NPI 1013223379
  Medicare reassignment NPD
• Margarita Hernandez, DPT

  • Physical Therapist
  • Santa Rosa, CA
  • NPI 1962040998
  Medicare reassignment NPD

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

{
    "created_epoch": "1518739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749686400000",
    "number": "1215437249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 CONCOURSE BLVD",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954038210",
            "telephone_number": "844-527-7369",
            "fax_number": "844-847-4943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 CONCOURSE BLVD",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954038210",
            "telephone_number": "844-527-7369",
            "fax_number": "844-847-4943"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5150 Hill Rd E Ste C",
            "address_purpose": "LOCATION",
            "city": "Lakeport",
            "state": "CA",
            "postal_code": "954535100",
            "country_code": "US",
            "telephone_number": "844-527-7369",
            "fax_number": "844-847-4943",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "181 Andrieux St Ste 107",
            "address_purpose": "LOCATION",
            "city": "Sonoma",
            "state": "CA",
            "postal_code": "954766920",
            "country_code": "US",
            "telephone_number": "844-527-7369",
            "fax_number": "844-847-4943",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EVOLVE RESTORATIVE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-16",
        "last_updated": "2025-06-12",
        "certification_date": "2025-06-12",
        "status": "A",
        "authorized_official_last_name": "BRUNTLETT",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "707-495-9632"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacey Evans
• Timothy P Everette, MFT INTERN
• Evergreen Pharmaceutical of California, LLC
• Jesse Evers
• Eileen Evind, ASW
• Joanne Ewart, M.S.
• Diana Ewing, LVN
• Eberle A. Ewing, MD
• Eye Associates of Sebastopol Medical Group
• Eye Care Institute, a Medical Corporation

• Interventional Pain Medicine Physician in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Interventional Pain Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.