NPIMap

Organization Active NPI

Evergreen Spine and Pain Centers

  • Interventional Pain Medicine Physician
  • Riverside, CA
National Provider Identifier
1760159198
Registry record updated Aug 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
EVERGREEN SPINE AND PAIN CENTERS
Practice address
3762 Tibbetts St
Riverside, CA 92506-2605
Phone
(949) 414-7246
NPI assigned
Aug 24, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2024

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

Authorized official

Name
Dr. Yi Cai Isaac Tong, MDNPI 1659678837
Title
Ceo
Phone
(917) 745-6888

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207L00000X
Pain Medicine (Anesthesiology) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207LP2900X
Interventional Pain Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208VP0014X Primary

Addresses

Primary practice location

3762 Tibbetts St
Riverside, CA 92506-2605

Mailing address

3762 Tibbetts St
Riverside, CA 92506-2605

Other practice location 1

10961 Westminster Ave
Garden Grove, CA 92843-4929
Phone (949) 414-7246

Other practice location 2

8965 Magnolia Ave
Riverside, CA 92503-4432
Phone (951) 689-5788

Other practice location 3

17040 Arnold Dr
Riverside, CA 92518-2813
Phone (951) 238-6803

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210916003002 CA Part B Supplier - Clinic/Group Practice 6507263688 Receives reassigned benefits from 8 practitioners
Practice locations: San Bernardino, CA; Riverside, CA; Redlands, CA; Pomona, CA; Long Beach, CA; Huntington Beach, CA; Grand Terrace, CA; Garden Grove, CA…

National Provider Directory

National Provider Directory

Locations

11162 Palm Terrace Ln
Riverside, CA 92505
Phone (951) 687-7330

Practitioners & affiliated clinicians

Practitioners 11

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

NPI Registry JSON

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

{
    "created_epoch": "1629763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724976000000",
    "number": "1760159198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3762 TIBBETTS ST",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925062605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3762 TIBBETTS ST",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925062605",
            "telephone_number": "949-414-7246"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10961 Westminster Ave",
            "address_purpose": "LOCATION",
            "city": "Garden Grove",
            "state": "CA",
            "postal_code": "928434929",
            "country_code": "US",
            "telephone_number": "949-414-7246",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8965 Magnolia Ave",
            "address_purpose": "LOCATION",
            "city": "Riverside",
            "state": "CA",
            "postal_code": "925034432",
            "country_code": "US",
            "telephone_number": "951-689-5788",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "17040 Arnold Dr",
            "address_purpose": "LOCATION",
            "city": "Riverside",
            "state": "CA",
            "postal_code": "925182813",
            "country_code": "US",
            "telephone_number": "951-238-6803",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EVERGREEN SPINE AND PAIN CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-24",
        "last_updated": "2024-08-30",
        "certification_date": "2024-08-30",
        "status": "A",
        "authorized_official_last_name": "TONG",
        "authorized_official_first_name": "YI CAI ISAAC",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "917-745-6888",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

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