Evergreen Prosthetics and Orthotics, LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

EVERGREEN PROSTHETICS AND ORTHOTICS, LLC

Practice address

5050 NE Hoyt St Ste B50
Portland, OR 97213-2957

Phone

(503) 467-4773

Fax

(503) 467-4775

NPI assigned

Jun 16, 2021

Organization subpart

No

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

Authorized official

Name

Tim O'Neill

Title

President

Phone

(503) 407-5408

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Nicole Halfman, LCPO

  • Prosthetist
  • Vancouver, WA
  • NPI 1386538833
  NPD (past)

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

{
    "created_epoch": "1623801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698796800000",
    "number": "1790353589",
    "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": "503-765-5081",
            "fax_number": "971-316-1553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5050 NE HOYT ST STE B50",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132957",
            "telephone_number": "503-467-4773",
            "fax_number": "503-467-4775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN PROSTHETICS AND ORTHOTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-16",
        "last_updated": "2023-11-01",
        "certification_date": "2023-11-01",
        "status": "A",
        "authorized_official_last_name": "O'NEILL",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-407-5408"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Evergreen Medical Solutions LLC
• Evergreen Oregon Healthcare Portland, L.L.C.
• Evergreen Pelvic Health and Wellness LLC
• Evergreen Pharmaceutical LLC
• Evergreen Prosthetics and Orthotics, LLC
• Evergreen Prosthetics and Orthotics, LLC
• Evergreen Prosthetics and Orthotics, LLC
• Evergreen Recovery Center
• Evergreen SNF Healthcare LLC
• Lorie Jean Everist

• Prosthetic/Orthotic Supplier in Portland, OR
• Providers in Portland, OR by specialty
• Prosthetic/Orthotic Supplier in Oregon

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.