Evolution Healthcare Management LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

EVOLUTION HEALTHCARE MANAGEMENT LLC

Practice address

7615 E Baseline Rd
Suite 101
Mesa, AZ 85209-8520

Phone

(480) 354-7878

NPI assigned

Sep 3, 2015

Organization subpart

No

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

Authorized official

Name

Fawn Michelle Boonstra

Title

President, Manager

Phone

(480) 286-7907

Specialties & licenses 1

Addresses

Other names 1

• EVOLUTION MANAGEMENT SERVICES COMPANY Former legal business name

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 6

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

• Ruth Kendra Rivera, FNP

  • Family Nurse Practitioner
  • Scottsdale, AZ
  • NPI 1871981076
  Medicare reassignment Care Compare group NPD
• Shiny Susan Thomas, NP

  • Adult Medicine Physician
  • Mesa, AZ
  • NPI 1558916247
  Medicare reassignment Care Compare group NPD
• Rachael Buckley, NP

  • Family Nurse Practitioner
  • Mesa, AZ
  • NPI 1215479829
  Medicare reassignment NPD
• Steven Joel King, PA-C

  • Medical Physician Assistant
  • Chandler, AZ
  • NPI 1629069083
  Medicare reassignment
• Shantha Kumar, M.D.

  • Cardiovascular Disease Physician
  • Apache Junction, AZ
  • NPI 1396768958
  Medicare reassignment
• Jismi Theeyattuveli, NP

  • Nurse Practitioner
  • Mesa, AZ
  • NPI 1285229534
  NPD (past)

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

{
    "created_epoch": "1441238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757635200000",
    "number": "1770951980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 S GOLD DR STE 6",
            "city": "APACHE JUNCTION",
            "state": "AZ",
            "postal_code": "851205036",
            "telephone_number": "480-354-7878",
            "fax_number": "949-577-4159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7615 E BASELINE RD",
            "address_2": "SUITE 101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852098520",
            "telephone_number": "480-354-7878"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "99 S Gold Dr",
            "address_2": "Ste. 6",
            "address_purpose": "LOCATION",
            "city": "Apache Junction",
            "state": "AZ",
            "postal_code": "851205035",
            "country_code": "US",
            "telephone_number": "620-694-3190",
            "fax_number": "480-962-0202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EVOLUTION HEALTHCARE MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-03",
        "last_updated": "2025-09-12",
        "certification_date": "2024-04-12",
        "status": "A",
        "authorized_official_last_name": "BOONSTRA",
        "authorized_official_first_name": "FAWN",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "PRESIDENT, MANAGER",
        "authorized_official_telephone_number": "480-286-7907"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EVOLUTION MANAGEMENT SERVICES COMPANY",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Evergreen Hospice, LLC.
• Evergreen Mesa Christian, L.L.C.
• Evergrove Integrative Health PLLC
• Every Smile Mesa, LLC
• Evmark Corp
• Evolution Vision Care, PLLC
• Evolution Way
• Evolve Diagnostics
• Evolve Health and Weight Solutions PLLC
• Becki Ewy, CPNP-PC

• Primary Care Clinic/Center in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Primary Care Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2025; 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.