EVERGREEN PROSTHETICS AND ORTHOTICS, LLC (NPI# 1003287269) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003287269 |
| Entity Type | Organization |
| Organization Name | EVERGREEN PROSTHETICS AND ORTHOTICS, LLC |
| Practice Address |
501 N Graham St Ste 255 Portland OR 97227-1654 |
| Mailing Address |
8880 Sw Nimbus Ave Ste A Beaverton OR 97008-7111 |
| Practice Telephone | 5032889929 |
| Practice Fax Number | 5032885904 |
| Mailing Telephone | 8779717272 |
| Mailing Fax Number | 9717273162 |
| Enumeration Date | 2015-10-14 |
| Last Update Date | 2020-02-11 |
| Authorized Official Name | TIMOTHY L O'NEILL (OWNER) |
| Authorized Official Telephone | 5034075408 |
| Authorized Official Credential | CPO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 335E00000X | Prosthetic/Orthotic Supplier | Suppliers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619508702 | Evergreen Prosthetics and Orthotics, LLC | Prosthetic/Orthotic Supplier | 1500 E Heritage Park St Ste 100, Meridian, ID 83646-5884 | 2020-01-28 |
| 1023503497 | Evergreen Prosthetics and Orthotics, LLC | Durable Medical Equipment & Medical Supplies | 1818 S 10th Ave Ste 240, Caldwell, ID 83605-4880 | 2018-06-27 |
| 1811269129 | Evergreen Prosthetics and Orthotics, LLC | Durable Medical Equipment & Medical Supplies | 911 Main St Ste 120, Oregon City, OR 97045-1867 | 2012-02-01 |
| 1831218767 | Evergreen Prosthetics and Orthotics, LLC | Durable Medical Equipment & Medical Supplies | 1940 Nw 24th Ave, Portland, OR 97210-2786 | 2007-03-29 |
| 1619096005 | Evergreen Prosthetics and Orthotics, LLC | Durable Medical Equipment & Medical Supplies | 11201 Ne 9th St, Suite 100, Vancouver, WA 98684 | 2007-03-28 |
| 1821037284 | Evergreen Prosthetics and Orthotics, LLC | Durable Medical Equipment & Medical Supplies | 862 Se Oak St Ste 2b, Hillsboro, OR 97123-4240 | 2006-06-04 |
| 1831739127 | Evergreen Prosthetics and Orthotics, LLC | Prosthetic/Orthotic Supplier | 24076 Se Stark St Ste 320, Gresham, OR 97030-3386 | 2020-01-14 |
| 1922662865 | Evergreen Prosthetics and Orthotics, LLC | Prosthetic/Orthotic Supplier | 425 S Whitley Dr Ste 431, Fruitland, ID 83619-2611 | 2019-04-25 |
| 1659813657 | Evergreen Prosthetics and Orthotics, LLC | Durable Medical Equipment & Medical Supplies | 1555 3rd Ave Ste B, Longview, WA 98632-3268 | 2016-11-08 |
| 1407300338 | Evergreen Prosthetics and Orthotics, LLC | Prosthetic/Orthotic Supplier | 1940 Nw 24th Ave, Portland, OR 97210-2786 | 2016-08-09 |
| Street Address |
501 N GRAHAM ST STE 255 |
| City | PORTLAND |
| State | OR |
| Zip Code | 97227-1654 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508869157 | Paula Deanne Dietsch Kuiper | Physician Assistant | 501 N Graham St, Suite 220, Portland, OR 97227-1654 | 2005-05-27 |
| 1811454432 | Matthew James Luttrell | Registered Nurse | 501 N Graham St, Portland, OR 97227-1654 | 2019-03-01 |
| 1831640267 | Morgan Sue Huey | Physician Assistant | 501 N Graham St, Suite 415, Portland, OR 97227-1654 | 2016-10-20 |
| 1093169583 | Theresa Mcsherry | Nurse Practitioner | 501 N Graham St, Suite 555, Portland, OR 97227-1654 | 2016-04-20 |
| 1093172702 | Jeremy Alper | Pharmacist | 501 N Graham St, Portland, OR 97227-1654 | 2016-01-26 |
| 1316321110 | Portland Ear, Nose & Throat Specialists | Specialist | 501 N Graham St, Suite 455, Portland, OR 97227-1654 | 2015-07-13 |
| 1942693908 | Leigh Warsing | Physician Assistant | 501 N Graham St, Suite 580, Portland, OR 97227-1654 | 2015-03-13 |
| 1134521909 | Justin Hadaller | Physician Assistant | 501 N Graham St, Suite 580, Portland, OR 97227-1654 | 2014-09-23 |
| 1932542503 | Erica T Ballard | Physician Assistant | 501 N Graham St, Ste 200, Portland, OR 97227-1654 | 2013-04-12 |
| 1346593357 | Portland Neurology & Sleep PC | Sleep Specialist, PhD | 501 N Graham St, Suite 515, Portland, OR 97227-1654 | 2012-10-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508466574 | Jessica Michelle Simonetti | Psychologist | Portland Psychotherapy Clinic, Research and Training Ce, 3700 N Williams Ave, Portland, OR 97227 | 2020-10-29 |
| 1447812268 | Maksim Yefimov | Physician Assistant | 2800 N Vancouver Ave Ste 130, Portland, OR 97227 | 2019-07-01 |
| 1851955975 | Erin Marie Staples | Student in an Organized Health Care Education/Training Program | 2800 N. Vancouver Ave;, Suite 230, Portland, OR 97227 | 2019-04-24 |
| 1922588508 | Melanie Grace Mix | Physician Assistant | 501 N Graham St Ste 420, Portland, OR 97227 | 2018-08-14 |
| 1730615071 | Mehran Giblin | Student in an Organized Health Care Education/Training Program | 2800 N. Vancouver Ave, Suite 230, Legacy Clinic Emanuel, Portland, OR 97227 | 2017-05-05 |
| 1730623687 | Christina Grace Belter | Optometrist | 300 N Graham St Ste 300, Portland, OR 97227 | 2016-12-12 |
| 1407300205 | Jenna Abernathy | Counselor | 3537 N Williams Ave, Portland, OR 97227 | 2016-08-09 |
| 1215390760 | Tanya Marie Woods | Massage Therapist | 3808 N. Williams Ave., Portland, OR 97227 | 2016-04-01 |
| 1033596853 | Eric Allen Martin | Counselor | 2054 N. Vancouver Ave, Portland, OR 97227 | 2015-04-30 |
| 1285040436 | Berk Neurosurgical LLC | Neurological Surgery | 501 N Graham St Ste 500, Portland, OR 97227 | 2014-07-09 |
| Find all providers in zip 97227 | ||||
| Taxonomy Code | 335E00000X |
| Grouping | Suppliers |
| Classification | Prosthetic/Orthotic Supplier |
| An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194023218 | Aryz Inc | Prosthetic/Orthotic Supplier | 671 Forest Ave, Portland, ME 04103-4158 | 2011-03-14 |
| 1023188778 | Orthotic Prosthetic Associates, Inc. | Prosthetic/Orthotic Supplier | 173 Ne 102nd Ave, Portland, OR 97220-4169 | 2006-11-09 |
| 1659306207 | Nordstrom Inc & Subsidiaries | Prosthetic/Orthotic Supplier | 1001 Lloyd Ctr, Portland, OR 97232-1238 | 2006-07-12 |
| 1669407219 | Nordstrom Inc & Subsidiaries | Prosthetic/Orthotic Supplier | 701 Sw Broadway, Portland, OR 97015-3301 | 2006-07-12 |
| 1902831563 | Nordstrom Inc & Subsidiaries | Prosthetic/Orthotic Supplier | 11900 Se 82nd Ave, Portland, OR 97086-7724 | 2006-07-12 |
| 1629003280 | Nordstrom Inc & Subsidiaries | Prosthetic/Orthotic Supplier | 9700 Sw Washington Square Rd, Portland, OR 97223-4453 | 2006-07-12 |
| 1265481758 | A Step Forward LLC | Prosthetic/Orthotic Supplier | 8605 Sw Terwilliger Blvd, Portland, OR 97219-4565 | 2006-05-10 |
| 1386602621 | East Side Orthotics & Prosthetics | Prosthetic/Orthotic Supplier | 17316 Ne Halsey St, Portland, OR 97230-6026 | 2006-05-03 |
| 1407811789 | Oregon Artificial Limb Co. | Prosthetic/Orthotic Supplier | 21 Ne Seventh Ave., Portland, OR 97232-2907 | 2006-04-19 |
| 1033112636 | Oregon Pedorthic Services | Prosthetic/Orthotic Supplier | 9932 Ne Halsey St, Portland, OR 97220-4474 | 2005-05-27 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.