NPIMap

Organization Active NPI

Evergreen Prosthetics and Orthotics, LLC

  • Prosthetic/Orthotic Supplier
  • Tillamook, OR
National Provider Identifier
1407212939
Registry record updated Nov 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
EVERGREEN PROSTHETICS AND ORTHOTICS, LLC
Practice address
210 Ivy Ave
Suite E
Tillamook, OR 97141-2216
Phone
(503) 354-5500
NPI assigned
Jan 13, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2023

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

Authorized official

Name
Timothy L O'Neill
Title
Owner
Phone
(503) 407-5408

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Prosthetic/Orthotic Supplier 335E00000X Primary

Addresses

Primary practice location

210 Ivy Ave
Suite E
Tillamook, OR 97141-2216

Mailing address

911 Main St Ste 100
Oregon City, OR 97045-1853
Phone (037) 655-0815

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160830001710 OR DME Supplier - Prosthetic PersonnelDME Supplier - Orthotic Personnel 5890906432 Practice locations: Tillamook, OR

Other NPIs with the same Medicare PAC ID 13

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

View all 13

Laboratory certificates & supplier records

Derived by NPIMap

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

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Evergreen Prosthetics & Orthotics210 Ivy Ave, Tillamook, OR 97141-2216(503) 354-5500 Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Prostheses|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom|Lymphedema Compression Treatment Items Does not accept assignmentParticipating since Jan 1, 2023

National Provider Directory

National Provider Directory
Tax ID family
Oregon Orthotic Services15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Locations

210 Ivy Ave
Ste E
Tillamook, OR 97141
Phone (503) 354-5500

NPI Registry JSON

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

{
    "created_epoch": "1452643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698796800000",
    "number": "1407212939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 MAIN ST STE 100",
            "city": "OREGON CITY",
            "state": "OR",
            "postal_code": "970451853",
            "telephone_number": "037-655-0815",
            "fax_number": "971-316-1553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 IVY AVE",
            "address_2": "SUITE E",
            "city": "TILLAMOOK",
            "state": "OR",
            "postal_code": "971412216",
            "telephone_number": "503-354-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN PROSTHETICS AND ORTHOTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-13",
        "last_updated": "2023-11-01",
        "certification_date": "2023-11-01",
        "status": "A",
        "authorized_official_last_name": "O'NEILL",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-407-5408"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tillamook, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.