Evergreen Pediatrics Inc

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A33613 Issued in CA

Legal business name

EVERGREEN PEDIATRICS INC

Practice address

4205 San Felipe Rd
#110
San Jose, CA 95135-1503

Phone

(408) 238-8303

Fax

(408) 238-8375

NPI assigned

Feb 2, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Pronoti Nigam, M.D.NPI 1053390310

Title

Physician

Phone

(408) 238-8303

Specialties & licenses 1

Addresses

Other identifiers 6

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 1

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

• Pronoti Nigam, MD

  • Pediatrics Physician
  • San Jose, CA
  • NPI 1053390310
  NPD (past) Authorized official

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380672000000",
    "number": "1972641736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4205 SAN FELIPE RD",
            "address_2": "#110",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951351503",
            "telephone_number": "408-238-8303",
            "fax_number": "408-238-8375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4205 SAN FELIPE RD",
            "address_2": "#110",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951351503",
            "telephone_number": "408-238-8303",
            "fax_number": "408-238-8375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN PEDIATRICS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2013-10-02",
        "status": "A",
        "authorized_official_last_name": "NIGAM",
        "authorized_official_first_name": "PRONOTI",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "408-238-8303",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A33613",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00C431251",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A336130",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS MEDICAL",
            "identifier": "R09208",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRONOTI NIGAM MD NPI",
            "identifier": "1053390310",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ZAHIDA P MALIKMD NPI",
            "identifier": "1750497608",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS MEDICAL",
            "identifier": "R09238",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Evergreen Hills Medical Group
• Evergreen Medical Associates Inc
• Evergreen Medical Group, Inc.
• Evergreen Natural Healing Arts
• Evergreen Pediatric Associates Inc.
• Evergreen Pharmacy Inc
• Evergreen Pharmacy Inc
• Evergreen Physical Therapy
• Evergreen Sleep Center
• Evergreen Surgery Center, LLC

• Pediatrics Physician in San Jose, CA
• Providers in San Jose, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.