NPIMap

Organization Active NPI

Evolve Restorative Center

  • Interventional Pain Medicine Physician
  • Santa Rosa, CA
National Provider Identifier
1215437249
Registry record updated Jun 12, 2025
On this page

Key facts

NPPES NPI Registry
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
Last updated
Jun 12, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2025

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

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208VP0014X Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

220 Concourse Blvd
Santa Rosa, CA 95403-8210

Mailing address

220 Concourse Blvd
Santa Rosa, CA 95403-8210
Phone (844) 527-7369

Other practice location 1

181 Andrieux St Ste 107
Sonoma, CA 95476-6920
Phone (844) 527-7369

Other practice location 2

5150 Hill Rd E Ste C
Lakeport, CA 95453-5100
Phone (844) 527-7369

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20180416002649 CA Part B Supplier - Clinic/Group Practice 0840553715 Receives reassigned benefits from 11 practitioners
Practice locations: Lakeport, CA; Santa Rosa, CA; Sonoma, CA
O20181002002593 CA DME Supplier - Physician - Anesthesiology 0840553715 Practice locations: Santa Rosa, CA

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2172616Evolve Restorative Center220 Concourse Blvd, Santa Rosa, CA 95403AccreditationJul 14, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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": "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"
        },
        {
            "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"
        }
    ],
    "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": []
}

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 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.