Evolve Medical Center, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

EVOLVE MEDICAL CENTER, LLC

Practice address

75-5722 Kuakini Hwy Ste 103
Kailua Kona, HI 96740-1721

Phone

(808) 444-3477

Fax

(808) 444-3478

NPI assigned

Jun 9, 2021

Last updated

Jul 5, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shannon Price-Schwartz, DO

Title

Owner

Phone

(808) 444-3477

Specialties & licenses 1

Addresses

Locations

Practitioners 3

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.

• Selena Rose Russo, PA-C

  • Physician Assistant
  • Aiea, HI
  • NPI 1801300694
  NPD (past)
• Nathan P Tomita, D.O.

  • Surgery Physician
  • Kailua Kona, HI
  • NPI 1255312401

  Single Specialty

  NPD (past)
• Ali Yasser El Sergany, M.D.

  • Family Medicine Physician
  • Riviera Beach, FL
  • NPI 1871650002
  NPD (past)

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

{
    "created_epoch": "1623196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720137600000",
    "number": "1366019143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75-5722 KUAKINI HWY STE 103",
            "city": "KAILUA KONA",
            "state": "HI",
            "postal_code": "967401721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75-5722 KUAKINI HWY STE 103",
            "city": "KAILUA KONA",
            "state": "HI",
            "postal_code": "967401721",
            "telephone_number": "808-444-3477",
            "fax_number": "808-444-3478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVOLVE MEDICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-09",
        "last_updated": "2024-07-05",
        "certification_date": "2024-07-05",
        "status": "A",
        "authorized_official_last_name": "PRICE-SCHWARTZ",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "808-444-3477",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Kailua Kona, HI
• Providers in Kailua Kona, HI by specialty
• Clinic/Center in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2024; 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.