EVERGREEN PEDIATRIC ASSOCIATES INC. - NPI 1215960455

Q: What is Evergreen Pediatric Associates Inc.'s NPI number?

The NPI number for Evergreen Pediatric Associates Inc. is 1215960455. It was assigned to this organization in the NPPES registry on July 9, 2006.

Q: What is Evergreen Pediatric Associates Inc.'s specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

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About Evergreen Pediatric Associates Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EVERGREEN PEDIATRIC ASSOCIATES INC. (NPI 1215960455) is a healthcare organization registered as a pediatrics in San Jose, California and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through October 3, 2026 and lists Linda M. Ha, Secretary, as its authorized official.

NPPES Registry Identity

NPI1215960455

Entity TypeOrganization

Primary Taxonomy208000000X

Legal Business NameEVERGREEN PEDIATRIC ASSOCIATES INC.

Location Address1642 E CAPITOL EXPYSan Jose, CA 95121-1800

Mailing Address1642 E Capitol ExpySan Jose, CA 95121-1800 · (408) 270-3374 · Fax (408) 270-3384

Phone(408) 270-3374

Fax(408) 270-3384

Organization SubpartNo

Authorized OfficialLinda M. HaSecretary · (408) 270-3374

Enumeration DateJuly 9, 2006

Last NPPES UpdateAugust 22, 2020

✔ NPI 1215960455 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians

Taxonomy Code208000000X

License✔ Licensed in CA · FNP32950

Definition

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

1642 E CAPITOL EXPY, San Jose, CA 95121

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Other Identifiers 1

MedicaidGR0102160CA

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D1059696

Evergreen Pediatric Associates, Inc · San Jose, CA

Active · expires Oct 3, 2026

CLIA Number05D1059696

Laboratory TypePhysician Office

Certificate Effective DateOctober 4, 2024

Certificate Expiration DateOctober 3, 2026

Laboratory DirectorDr. Linda M. Ha

Laboratory Phone(408) 270-3374

Laboratory LocationEvergreen Pediatric Associates, Inc1569 Lexannave Ste 232, San Jose, CA 95121

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. SARAH AOI GASKINS M.D.

Psychiatry & Neurology (Neurology)