NPIMap

Organization Active NPI

Evolve Brain Health LLC

Doing business as Evolve

  • Psychiatry Physician
  • Stamford, CT
National Provider Identifier
1740916105
Registry record updated Sep 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
EVOLVE BRAIN HEALTH LLC
Doing business as
Evolve
Practice address
1055 Summer St
Stamford, CT 06905-5527
Phone
(203) 504-9758
Fax
(203) 504-9758
NPI assigned
Jul 28, 2022
Last updated
Sep 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2024

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

Authorized official

Name
Dr. Thomas Joseph Knightly Jr., MDNPI 1447771282
Title
Owner
Phone
(978) 857-1424

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

1055 Summer St
Stamford, CT 06905-5527

Mailing address

1055 Summer St Ste 2
Stamford, CT 06905-5527
Phone (203) 504-9758

Other names 1

  • Evolve Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20221219001900 CT Part B Supplier - Clinic/Group Practice 9537538244 Receives reassigned benefits from 6 practitioners
Practice locations: Stamford, CT
O20260304000421 NY Part B Supplier - Clinic/Group Practice 9537538244 Receives reassigned benefits from 5 practitioners
Practice locations: Albany, NY

National Provider Directory

National Provider Directory

Locations

1055 Summer St
Stamford, CT 06905
Phone (203) 504-9758

1055 Summer St
Ste 2
Stamford, CT 06905
Phone (203) 504-9758

418 Broadway
#6409
Albany, NY 12207
Phone (203) 504-9758

Practitioners & affiliated clinicians

Practitioners 8

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": "1658966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727654400000",
    "number": "1740916105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 SUMMER ST STE 2",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069055527",
            "telephone_number": "203-504-9758",
            "fax_number": "203-547-4914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 SUMMER ST",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069055527",
            "telephone_number": "203-504-9758",
            "fax_number": "203-504-9758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVOLVE BRAIN HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-28",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-30",
        "status": "A",
        "authorized_official_last_name": "KNIGHTLY",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "978-857-1424",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evolve",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Evolve",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stamford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2024; 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.