Evergreen Retirement Community, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

2057 Issued in WI

Legal business name

EVERGREEN RETIREMENT COMMUNITY, INC.

Practice address

1130 N Westfield St
Oshkosh, WI 54902-3217

Phone

(920) 233-2340

Fax

(920) 237-2109

NPI assigned

Aug 24, 2005

Last updated

Jul 29, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Peggy F Bellin, RN

Title

Health Center Administrator

Phone

(920) 237-6200

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144213281. Details of each certification follow.

• CCN 525647 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 525647

Legal name

EVERGREEN RETIREMENT COMMUNITY INC

Doing business as

EVERGREEN HEALTH CENTER

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Apr 1, 1999

Last certification

Mar 12, 2025

Beds

80

Ownership / control type

Nonprofit Corporation

Organization structure

CorporationNon-profit

Incorporated

Mar 31, 1965 in WI

Enrollment address

1130 N Westfield St
Oshkosh, WI 54902-3217

Nursing home name

EVERGREEN HEALTH CENTER

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Evergreen Retirement Community, Inc.

  dba Evergreen At Home

  • Home Health Agency
  • Oshkosh, WI
  • NPI 1588097810

  7416963384

  Same PAC ID

Listed as

Evergreen Health CenterCCN 525647 · All quality measures

Overall star rating

4 of 5

Health inspections

4 of 5

Staffing

4 of 5

Quality measures

4 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Corporation

Certified

Apr 1, 1999

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

8057.0 residents per day on average

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Evergreen Retirement Community Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Evergreen Retirement Community, Inc.

  dba Evergreen At Home

  • Home Health Agency
  • Oshkosh, WI
  • NPI 1588097810
  NPD tax ID

All disclosed owners & managing parties 30

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Evergreen Retirement Community, Inc.

  dba Evergreen At Home

  • Home Health Agency
  • Oshkosh, WI
  • NPI 1588097810

  5% Or Greater Direct Ownership Interest, Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Phyllis Lee, MD

  • Family Medicine Physician
  • Oshkosh, WI
  • NPI 1124010749

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

• Baycare Aurora, LLC

  • General Acute Care Hospital
  • Green Bay, WI
  • NPI 1255387726

  Aurora Medical Group, Inc.

  CMS ownership

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Evergreen Retirement Community, Inc.

  dba Evergreen At Home

  • Home Health Agency
  • Oshkosh, WI
  • NPI 1588097810
  NPPES parent name

Affiliated clinicians 14

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Ammar Alzoubi, MD

  • Internal Medicine Physician
  • Oshkosh, WI
  • NPI 1598773152

  Nursing home

  Care Compare affiliation
• Eric C Duwell, MD

  • Family Medicine Physician
  • Oshkosh, WI
  • NPI 1710092978

  Nursing home

  Care Compare affiliation
• Jeffrey Allen Farvour, MD

  • Family Medicine Physician
  • Oshkosh, WI
  • NPI 1669931978

  Nursing home

  Care Compare affiliation
• Kaylee Lynn Hawks, FNP-C

  • Nurse Practitioner
  • Manitowoc, WI
  • NPI 1003520255

  Nursing home

  Care Compare affiliation
• Benjamin Joseph Heinzen, M.D.

  • Internal Medicine Physician
  • Oshkosh, WI
  • NPI 1083886733

  Nursing home

  Care Compare affiliation
• Matthew Krueger Jenson, MD

  • Family Medicine Physician
  • Green Bay, WI
  • NPI 1063917243

  Nursing home

  Care Compare affiliation
• Kelsey Kienert, M.D.

  • Internal Medicine Physician
  • Neenah, WI
  • NPI 1134501190

  Nursing home

  Care Compare affiliation
• Kassondra K Korth, APNP

  • Family Nurse Practitioner
  • Oshkosh, WI
  • NPI 1336639202

  Nursing home

  Care Compare affiliation
• Teresa H Lee, MD

  • Internal Medicine Physician
  • Oshkosh, WI
  • NPI 1700871209

  Nursing home

  Care Compare affiliation
• Surendra Patel, M.D.

  • Internal Medicine Physician
  • Waukesha, WI
  • NPI 1265748404

  Nursing home

  Care Compare affiliation
• Weston William Radford, M.D.

  • Internal Medicine Physician
  • Oshkosh, WI
  • NPI 1700229416

  Nursing home

  Care Compare affiliation
• Christopher E Rocke, DO

  • Family Medicine Physician
  • Oshkosh, WI
  • NPI 1417942996

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1124841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659052800000",
    "number": "1144213281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 N WESTFIELD ST",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549023217",
            "telephone_number": "920-233-2340",
            "fax_number": "920-237-2109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 N WESTFIELD ST",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549023217",
            "telephone_number": "920-233-2340",
            "fax_number": "920-237-2109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN RETIREMENT COMMUNITY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-24",
        "last_updated": "2022-07-29",
        "certification_date": "2022-07-29",
        "status": "A",
        "authorized_official_last_name": "BELLIN",
        "authorized_official_first_name": "PEGGY",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "HEALTH CENTER ADMINISTRATOR",
        "authorized_official_telephone_number": "920-237-6200",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "2057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20136400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Oshkosh, WI
• Providers in Oshkosh, WI by specialty
• Skilled Nursing Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.