NPIMap

Organization Active NPI

Evergreen Medical Group, Inc.

  • Rheumatology Physician
  • San Jose, CA
National Provider Identifier
1508159294
Registry record updated Mar 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
License
A100943 Issued in CA
Legal business name
EVERGREEN MEDICAL GROUP, INC.
Practice address
2690 S White Rd Ste 50
San Jose, CA 95148-2075
Phone
(408) 223-7000
Fax
(408) 223-7001
NPI assigned
May 27, 2011
Last updated
Mar 5, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2012

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

Authorized official

Name
Dr. Lily Kao, M.D.NPI 1578742888
Title
Physician
Phone
(408) 223-7000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rheumatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RR0500X A100943 CA Primary

Addresses

Primary practice location

2690 S White Rd Ste 50
San Jose, CA 95148-2075

Mailing address

2690 S White Rd Ste 50
San Jose, CA 95148-2075
Phone (408) 223-7000

National Provider Directory

National Provider Directory

Locations

2690 S White Rd
Ste 50
San Jose, CA 95148
Phone (408) 223-7000

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 12

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": "1306454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330905600000",
    "number": "1508159294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2690 S WHITE RD STE 50",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951482075",
            "telephone_number": "408-223-7000",
            "fax_number": "408-223-7001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2690 S WHITE RD STE 50",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951482075",
            "telephone_number": "408-223-7000",
            "fax_number": "408-223-7001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-27",
        "last_updated": "2012-03-05",
        "status": "A",
        "authorized_official_last_name": "KAO",
        "authorized_official_first_name": "LILY",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "408-223-7000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": "CA",
            "license": "A100943",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2012; 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.