Evergreen Regenerative Medicine and Rehabilitation PC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

EVERGREEN REGENERATIVE MEDICINE AND REHABILITATION PC

Practice address

707 Murphy Rd
Medford, OR 97504-8520

Phone

(541) 414-0455

Fax

(541) 414-0450

NPI assigned

Oct 7, 2021

Organization subpart

No

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

Authorized official

Name

David E Harris

Title

President/Owner

Phone

(541) 414-0455

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Noel Needham

  • Psychiatric/Mental Health Registered Nurse
  • Grants Pass, OR
  • NPI 1154257277
  NPD

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

{
    "created_epoch": "1633564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638662400000",
    "number": "1003578907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 MURPHY RD STE 101",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048520",
            "telephone_number": "541-414-0455",
            "fax_number": "541-414-0450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 MURPHY RD",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048520",
            "telephone_number": "541-414-0455",
            "fax_number": "541-414-0450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN REGENERATIVE MEDICINE AND REHABILITATION PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-07",
        "last_updated": "2021-12-05",
        "certification_date": "2021-12-05",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "541-414-0455"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500679386",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Roderick Evans, CRM
• Stephanie Michelle Evans
• Thomas Russell Evans, DO
• Christine Louise Everaert, MSOTRL
• Evergreen Counseling & Life Skills, LLC
• Serafina Eliya Evergreen
• Deborah Lynn Evertt, QMHA
• Every Word Counts
• Thomas M Ewald, MD
• Angela R Ewing, LPC

• Physical Medicine & Rehabilitation Physician in Medford, OR
• Providers in Medford, OR by specialty
• Physical Medicine & Rehabilitation Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2021; 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.