Evolution Health & Performance LLC

Primary specialty

Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X

Legal business name

EVOLUTION HEALTH & PERFORMANCE LLC

Practice address

244 S. Palmetto Ave
Daytona Beach, FL 32114

Phone

(386) 310-2385

Fax

(386) 233-9488

NPI assigned

Jul 7, 2020

Last updated

Jul 7, 2020By 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

Bobby John Ardila, PANPI 1699737783

Title

Owner/PA

Phone

(407) 739-2395

Specialties & licenses 2

Addresses

Locations

Practitioners 1

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.

• Bobby John Ardila, PA-C

  • Surgical Physician Assistant
  • Celebration, FL
  • NPI 1699737783
  NPD Authorized official

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

{
    "created_epoch": "1594080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594080000000",
    "number": "1376161380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "244 S. PALMETTO AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "32114",
            "telephone_number": "386-310-2385",
            "fax_number": "386-233-9488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "244 S. PALMETTO AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "32114",
            "telephone_number": "386-310-2385",
            "fax_number": "386-233-9488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVOLUTION HEALTH & PERFORMANCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-07",
        "last_updated": "2020-07-07",
        "certification_date": "2020-07-07",
        "status": "A",
        "authorized_official_last_name": "ARDILA",
        "authorized_official_first_name": "BOBBY",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "OWNER/PA",
        "authorized_official_telephone_number": "407-739-2395",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Emergency Medical Services (Emergency Medicine) Physician in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Emergency Medical Services (Emergency Medicine) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2020; 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.