Evergreen Oculofacial Plastic Surgery LLC

Primary specialty

Ophthalmic Plastic and Reconstructive Surgery PhysicianTaxonomy code 207WX0200X

Legal business name

EVERGREEN OCULOFACIAL PLASTIC SURGERY LLC

Practice address

929 SW Simpson Ave Ste 250
Bend, OR 97702-3599

Phone

(541) 585-0505

NPI assigned

Jan 4, 2022

Last updated

Mar 20, 2024By 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

Tara Marie Goecks, MDNPI 1598051732

Title

Owner

Phone

(303) 228-3220

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CO, OR2 enrollments

Enrollment records 2

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tara Marie Goecks, MD

  • Ophthalmic Plastic and Reconstructive Surgery Physician
  • Bend, OR
  • NPI 1598051732

  CO

  Medicare reassignment Authorized official
• Catherine Ruth Sheldon Platt, MD

  • Interventional Pain Medicine Physician
  • Bend, OR
  • NPI 1568452589
  NPD
• Theodore Rowe Ford, MD

  • Interventional Pain Medicine Physician
  • Bend, OR
  • NPI 1205940830
  NPD (past)

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

{
    "created_epoch": "1641254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710892800000",
    "number": "1669133492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6387",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977086387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "929 SW SIMPSON AVE STE 250",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977023599",
            "telephone_number": "541-585-0505"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1190 Bookcliff Ave Unit 102",
            "address_purpose": "LOCATION",
            "city": "Grand Junction",
            "state": "CO",
            "postal_code": "815018159",
            "country_code": "US",
            "telephone_number": "303-228-3220",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EVERGREEN OCULOFACIAL PLASTIC SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-04",
        "last_updated": "2024-03-20",
        "certification_date": "2024-03-20",
        "status": "A",
        "authorized_official_last_name": "GOECKS",
        "authorized_official_first_name": "TARA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-228-3220",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207WX0200X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "1598051732",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Evens Physical Therapy
• Timothy R Evens, PT
• Stephanie Elissa Everett, ED. S., NCSP
• Evergreen Behavior Services, LLC
• Evergreen Home Services, Inc.
• Tamara Ann Everhart, FNP
• Diana Marie Everly
• Everwell Medicine
• Evoke
• Evoke

• Ophthalmic Plastic and Reconstructive Surgery Physician in Bend, OR
• Providers in Bend, OR by specialty
• Ophthalmic Plastic and Reconstructive Surgery Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.