NPIMap

Organization Active NPI

Evergreen Eye Center, PLLC

Doing business as Evergreen Eye Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Seattle, WA
National Provider Identifier
1871095489
Registry record updated Jan 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
EVERGREEN EYE CENTER, PLLC
Doing business as
Evergreen Eye Surgery Center
Practice address
1229 Madison St Ste 1250
Seattle, WA 98104-3568
Phone
(206) 212-2100
Fax
(206) 212-2194
NPI assigned
Feb 28, 2018
Last updated
Jan 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2024

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

Authorized official

Name
Rosa Angelica Campos
Title
Credentialing Manager
Phone
(206) 215-2004

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

1229 Madison St Ste 1250
Seattle, WA 98104-3568

Mailing address

1229 Madison St Ste 1250
Seattle, WA 98104-3568
Phone (206) 212-2100

Other practice location 1

1229 Madison St Ste 1250
Seattle, WA 98104-3568
Phone (206) 212-2100

Other names 1

  • Evergreen Eye Surgery Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180716000110 WA Part B Supplier - Ambulatory Surgical Center 3173410057 Practice locations: Seattle, WA

Other NPIs with the same Medicare PAC ID 4

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

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Evergreen Eye CenterCCN 50C0001247
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Evergreen Eye Center PLLC11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

NPI Registry JSON

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

{
    "created_epoch": "1519776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705017600000",
    "number": "1871095489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1229 MADISON ST STE 1250",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981043568",
            "telephone_number": "206-212-2100",
            "fax_number": "206-212-2194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1229 MADISON ST STE 1250",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981043568",
            "telephone_number": "206-212-2100",
            "fax_number": "206-212-2194"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1229 Madison St Ste 1250",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981043568",
            "country_code": "US",
            "telephone_number": "206-212-2100",
            "fax_number": "206-212-2194",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EVERGREEN EYE CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-28",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-12",
        "status": "A",
        "authorized_official_last_name": "CAMPOS",
        "authorized_official_first_name": "ROSA",
        "authorized_official_middle_name": "ANGELICA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "206-215-2004"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Eye Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2024; 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.