Evolution MD, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

EVOLUTION MD, LLC

Practice address

4127 Mexico Rd
Saint Peters, MO 63376-6410

Phone

(636) 534-0200

Fax

(636) 534-0211

NPI assigned

Mar 25, 2022

Organization subpart

No

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

Authorized official

Name

Jose Marino Parra, MDNPI 1821283193

Title

Owner

Phone

(636) 534-0200

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jose Marino Parra, MD

  • Sports Medicine (Family Medicine) Physician
  • Creve Coeur, MO
  • NPI 1821283193
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1648166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785888000000",
    "number": "1699425314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 37002",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631411502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4127 MEXICO RD",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633766410",
            "telephone_number": "636-534-0200",
            "fax_number": "636-534-0211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVOLUTION MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-25",
        "last_updated": "2026-08-05",
        "certification_date": "2026-08-05",
        "status": "A",
        "authorized_official_last_name": "PARRA",
        "authorized_official_first_name": "JOSE",
        "authorized_official_middle_name": "MARINO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "636-534-0200",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer L Etling, MD
• Cassandra Eubanks, LPC
• Laurie J Evans-Schoenecker, LCSW
• James Glennon Evans, D.D.S.
• Joseph Charles Evola, DMD
• Executive Centre Surgical Services
• Raymond Fada Jr., O.D.
• Romulo Joven Fajatin, MD
• Meredith Leigh Fallert, RD
• Zachary Patrick Fallon, M.D.

• Family Medicine Physician in Saint Peters, MO
• Providers in Saint Peters, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.