Evergreen Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

EVERGREEN SURGERY CENTER, LLC

Practice address

2365 Quimby Rd Ste 180
San Jose, CA 95122-1337

Phone

(408) 620-5675

Fax

(408) 223-1534

NPI assigned

Sep 21, 2016

Last updated

Feb 4, 2019By 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

Dr. Hector Cervantes, DPM

Title

Partner

Phone

(408) 620-5723

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

Evergreen Surgery Center LLCCCN 05C0002183

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Practitioners 2

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.

• Michael M Jadali, D.O. , RPH

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • San Jose, CA
  • NPI 1891723375
  NPD
• Mohammed Habeeb Ahmed, M.D.

  • Cardiovascular Disease Physician
  • San Jose, CA
  • NPI 1770593105
  NPD (past)

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

{
    "created_epoch": "1474416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549238400000",
    "number": "1538618368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2365 QUIMBY RD STE 180",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951221337",
            "telephone_number": "408-620-5675",
            "fax_number": "408-223-1534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2365 QUIMBY RD STE 180",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951221337",
            "telephone_number": "408-620-5675",
            "fax_number": "408-223-1534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-21",
        "last_updated": "2019-02-04",
        "status": "A",
        "authorized_official_last_name": "CERVANTES",
        "authorized_official_first_name": "HECTOR",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "408-620-5723",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Evergreen Pediatrics Inc
• Evergreen Pharmacy Inc (Evergreen Pharmacy)
• Evergreen Pharmacy Inc
• Evergreen Physical Therapy
• Evergreen Sleep Center
• Evergreen Urgent Care Inc
• Evergreen Valley Home Health LLC
• Jacinta Evergreen
• Everguard Home Care LLC
• Kate Shirley Everhardt

• Ambulatory Surgical Clinic/Center in San Jose, CA
• Providers in San Jose, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2019; 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.