EVERGREEN FAMILY MEDICINE, PC (NPI# 1417929050) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417929050 |
| Entity Type | Organization |
| Organization Name | EVERGREEN FAMILY MEDICINE, PC |
| Practice Address |
2570 Nw Edenbower Blvd Ste 100 Roseburg OR 97471-6214 |
| Mailing Address |
2570 Nw Edenbower Blvd Ste 100 Roseburg OR 97470-6214 |
| Practice Telephone | 5412293301 |
| Practice Fax Number | 5416777462 |
| Mailing Telephone | 5412293301 |
| Mailing Fax Number | 5416777462 |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2009-12-11 |
| Authorized Official Name | DR. TIMOTHY J POWELL (PRESIDENT) |
| Authorized Official Telephone | 5412293301 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207P00000X | Emergency Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 000116 | 05 | |
| OR | GROUP RAILROAD | CN5472 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528164936 | Evergreen Family Medicine, PC | Family Medicine | 4079 Lake Rd N, Brockport, NY 14420-1517 | 2006-09-15 |
| Street Address |
2570 NW EDENBOWER BLVD STE 100 |
| City | ROSEBURG |
| State | OR |
| Zip Code | 97471-6214 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962978866 | Kaitlyn E Bogardus | Physician Assistant | 2570 Nw Edenbower Blvd Ste 100, Roseburg, OR 97471-6214 | 2018-10-17 |
| 1629508957 | Natalie Moffett | Family Medicine | 2570 Nw Edenbower Blvd Ste 100, Roseburg, OR 97471-6214 | 2017-06-19 |
| 1427587948 | Dustin Meyers | Family Medicine | 2570 Nw Edenbower Blvd Ste 100, Roseburg, OR 97471-6214 | 2017-06-08 |
| 1730613837 | Alexandra Ann Blaine | Physician Assistant | 2570 Nw Edenbower Blvd Ste 100, Roseburg, OR 97471-6214 | 2017-04-14 |
| 1134576572 | Scott O Goebel | Physician Assistant | 2570 Nw Edenbower Blvd Ste 100, Roseburg, OR 97471-6214 | 2016-05-16 |
| 1912255191 | Brianna Nicole Lafayette Posen | Physician Assistant | 2570 Nw Edenbower Blvd Ste 100, Roseburg, OR 97471-6214 | 2012-08-20 |
| 1033406053 | Brandon W Bonds | Family Medicine | 2570 Nw Edenbower Blvd Ste 100, Roseburg, OR 97471-6214 | 2011-06-29 |
| 1346472347 | Nicole M Engler | Nurse Practitioner | 2570 Nw Edenbower Blvd Ste 100, Roseburg, OR 97471-6214 | 2009-08-10 |
| 1164627667 | Heidi Margaret Beery | Family Medicine | 2570 Nw Edenbower Blvd Ste 100, Roseburg, OR 97471-6214 | 2007-06-15 |
| 1033237227 | Primary Care Network LLC | Preferred Provider Organization | 2570 Nw Edenbower Blvd Ste 100, Roseburg, OR 97470-6214 | 2007-03-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841805660 | Rae Ann Barnes | Pharmacist | 913 Ne Garden Valley Blvd, Pharmacy, Roseburg, OR 97471 | 2020-09-09 |
| 1023651031 | Colton Phillips | Behavioral Analyst | 940 Nw Garden Valley Bvld #104, Roseburg, OR 97471 | 2019-10-22 |
| 1952884876 | Meredith Krugel Lcsw PC | Clinic/Center | 2225 Nw Stewart Parkway Ste 200, Roseburg, OR 97471 | 2018-09-07 |
| 1114456563 | Philip Kaser Family, LLC | Pharmacy | 1175 W. Harvard Avenue, Roseburg, OR 97471 | 2017-06-08 |
| 1053854208 | Icco LLC | Clinic/Center | 1740 Nw Goetz Street, Roseburg, OR 97471 | 2016-11-21 |
| 1770034589 | Evie Jepsen | Case Manager/Care Coordinator | 2700 Stewart Parkway Annex B, Suite 110, Roseburg, OR 97471 | 2016-10-17 |
| 1932551256 | Jonathan Schmidt | Licensed Practical Nurse | 913 Nm Garden Valley Blvd, Va Roseburg Medical Center, Roseburg, OR 97471 | 2016-07-11 |
| 1932580586 | Jeffrey Mark Wareham | Case Manager/Care Coordinator | 2700 Medical Loop, Annex B, Roseburg, OR 97471 | 2015-06-09 |
| 1558784215 | Ginger Jean Thibedeau | Massage Therapist | 3019 Nw Stewart Parkway, Suite 304 #183, Roseburg, OR 97471 | 2014-01-30 |
| 1427303122 | Karishma Parekh | Internal Medicine | 2460 Nw Stewart Pkwy Ste 103, Roseburg, OR 97471 | 2012-07-18 |
| Find all providers in zip 97471 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083113245 | Centennial Medical Group East, LLC | Family Medicine | 2510 Nw Edenbower Blvd Ste 152, Roseburg, OR 97471-8899 | 2018-02-02 |
| 1093974107 | Gerald A. Jaworski, M.d., P.C. | Family Medicine | 2282 Nw Troost St Ste 101, Roseburg, OR 97470-6072 | 2008-06-03 |
| 1831230242 | Darryl Brett George | Family Medicine | 455 W Corey Ct, Roseburg, OR 97470-3078 | 2007-02-09 |
| 1629085907 | Rodney Earl Todd | Family Medicine | 2282 Nw Troost St Ste 103, Roseburg, OR 97471-6072 | 2006-08-01 |
| 1780699645 | Augustin Karl Gombart | Family Medicine | 532 W Umpqua St, Roseburg, OR 97470-2951 | 2006-07-29 |
| 1174537047 | Diane Bolduc | Family Medicine | 340 Medical Loop, Roseburg, OR 97470-1645 | 2006-07-28 |
| 1790748028 | Cory L Russell | Family Medicine | 2570 Nw Edenbower Blvd., Ste 100, Roseburg, OR 97471 | 2006-04-08 |
| 1689647844 | Timothy J Powell | Family Medicine | 1937 W Harvard Ave, Roseburg, OR 97471-2720 | 2006-02-08 |
| 1144293648 | Charlton Bryan Mcnutt | Family Medicine | 150 Kenneth Ford Drive, Roseburg, OR 97470-1042 | 2006-02-07 |
| 1598737033 | Laurance Walter Choate | Family Medicine | 1813 W Harvard Ave Ste 201, Roseburg, OR 97471-2754 | 2006-02-07 |
| Find all providers in ROSEBURG | ||||
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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.