EVERGREEN PROSTHETICS AND ORTHOTICS, LLC
NPI 1063184141
Prosthetic/Orthotic Supplier in Vancouver, WA
NPI Status: Active since September 28, 2021
Contact Information
2121 NE 139TH ST
BLDG 1 STE 225
VANCOUVER, WA
ZIP 98686
Phone: (503) 765-5081
- Organization
- Prosthetic/Orthotic Supplier
- Medicare Supplier
- Does Not Accept Medicare Approved Payment
- CLIA Number: 50D2033564
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 04-04-2028
About EVERGREEN PROSTHETICS AND ORTHOTICS, LLC
This page provides the complete NPI Profile along with additional information for Evergreen Prosthetics And Orthotics, Llc, a provider established in Vancouver, Washington operating as a Prosthetic/orthotic Supplier. The healthcare provider is registered in the NPI registry with number 1063184141 assigned on September 2021. The practitioner's primary taxonomy code is 335E00000X. The provider is registered as an organization and their NPI record was last updated 2 years ago. The authorized official of this NPI record is Tim O'neill Cpo (President)
- NPI
- 1063184141
- Provider Name
- EVERGREEN PROSTHETICS AND ORTHOTICS, LLC
- Entity Type
- Organization
- Location Address
- 2121 NE 139TH ST BLDG 1 STE 225 VANCOUVER, WA 98686
- Location Phone
- (503) 765-5081
- Mailing Address
- 911 MAIN ST STE 100 OREGON CITY, OR 97045
- Mailing Phone
- (503) 765-5081
- Mailing Fax
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 09-28-2021
- Last Update Date
- 11-01-2023
- Code Navigator
Evergreen Prosthetics And Orthotics, Llc is a medicare supplier with PTAN 20331755 who does not accept Medicare assignment for all durable medical equipment and supplies. The provider may not accept the Medicare allowable as payment in full and may collect additional payment directly from the patient, and/or charge more than the Medicare allowable.The supplier carries the following product categories: Orthoses: Custom Fabricated or Orthoses: Prefabricated (Non-Custom Fabricated) or Orthoses: Off-The-Shelf or Limb Prostheses or Diabetic Shoes and Inserts or Diabetic Shoes/Inserts - Custom.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Prosthetic/Orthotic Supplier
- Taxonomy Code
- 335E00000X
- Type
- Suppliers
- Taxonomy Description
- An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition.
Medical Equipment Supplier
The provider carries the following medical supplies product categories:
- PTAN
- 20331755
- Accepts Medicare Assignment
- NO
- Specialities List
- Orthotic Personnel, Prosthetic Personnel.
- Competitive Bidding
- NO
Supplies List
- Orthoses: Custom Fabricated - Custom met pads, Custom heel pads, Custom heel spur pads
- Orthoses: Prefabricated (Non-Custom Fabricated) - Met pads, Heel pads, Heel spur pads
- Orthoses: Off-The-Shelf - Met pads, Heel pads, Heel spur pads
- Limb Prostheses - Prosthetic arms, Prosthetic feet, Prosthetic knees
- Diabetic Shoes and Inserts - Shoes, Socks, Insoles
- Diabetic Shoes/Inserts - Custom - Custom fabricated shoes, socks, & insoles
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 50D2033564
- Facility Type
- Physician Office
- Certificate Effective Date
- December 06, 2011
- Certificate Expiration Date
- April 04, 2028
- Laboratory Director
- SUSAN CUNEO
- Certificate Type
- Certificate for Provider-Performed Microscopy Procedures (PPMP)
- Certificate Type Description
- This CLIA certificate is issued to Evergreen Prosthetics And Orthotics, Llc in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 0 | 6 | 3 | 1 | 8 | 4 | 1 | 4 | 1 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 0 | 12 | 3 | 2 | 8 | 8 | 1 | 8 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 0 + 1 + 2 + 3 + 2 + 8 + 8 + 1 + 8 + 24 = 59 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 60 - 59 = 1 | 1 | ||||||||
The NPI number 1063184141 is valid because the calculated check digit 1 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 20 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1114948668 | KIMBERLY H. COPELAND MD Individual | Pediatrics | 2121 NE 139TH ST SUITE 200 VANCOUVER, WA 98686 (360) 487-1777 |
| 1477659233 | ELIZABETH ANNE SMYERS OTR/L Individual | Occupational Therapist (Pediatrics) | 2121 NE 139TH ST VANCOUVER, WA 98686 (360) 487-1777 |
| 1457412512 | NANCY R. PARSONS PT Individual | Physical Therapist | 2121 NE 139TH ST VANCOUVER, WA 98686 (360) 487-3750 |
| 1043371024 | CARA SCHMITT PT Individual | Speech-Language Pathologist | 2121 NE 139TH ST VANCOUVER, WA 98686 (360) 487-3750 |
| 1114070455 | TATIANA LVOVNA PETERSON MD Individual | Internal Medicine | 2121 NE 139TH ST VANCOUVER, WA 98686 (360) 487-1000 |
| 1124237599 | KARA A CASSAR M.S. CCC-SLP Individual | Speech-Language Pathologist | 2121 NE 139TH ST MOB A SUITE 200 VANCOUVER, WA 98686 (360) 487-1777 |
| 1124208384 | AMBER D BURNETT SPT Individual | Speech-Language Pathologist | 2121 NE 139TH ST MOB A SUITE 200 VANCOUVER, WA 98686 (360) 487-1777 |
| 1275713562 | JOY KINKAID O.T. Individual | Occupational Therapist | 2121 NE 139TH ST MOB A SUITE 200 VANCOUVER, WA 98686 (503) 413-3900 |
| 1689855249 | LISA M LYONS PH.D. Individual | Speech-Language Pathologist | 2121 NE 139TH ST MOB A, SUITE 200 VANCOUVER, WA 98686 (360) 487-1777 |
| 1659554665 | KATIE GODT PT Individual | Physical Therapist (Pediatrics) | 2121 NE 139TH ST MOB-A, SUITE 200 VANCOUVER, WA 98686 (360) 487-1777 |
| 1265615140 | REBECCA C SILVERMAN PT Individual | Physical Therapist (Pediatrics) | 2121 NE 139TH ST MOB - A, SUITE 200 VANCOUVER, WA 98686 (360) 487-1777 |
| 1790945681 | JOANNA RASMUSSEN M.S. CCC-SLP Individual | Speech-Language Pathologist | 2121 NE 139TH ST BUILDING A, SUITE #200 VANCOUVER, WA 98686 (360) 487-1780 |
| 1851542302 | IRENE W CHONG SLP Individual | Speech-Language Pathologist | 2121 NE 139TH ST VANCOUVER, WA 98686 (360) 487-1777 |
| 1619128188 | MIEKE K SCHMIDT PT Individual | Physical Therapist (Pediatrics) | 2121 NE 139TH ST VANCOUVER, WA 98686 (360) 487-1777 |
| 1831322114 | EMANUELA REZNIC MA-SLP Individual | Speech-Language Pathologist | 2121 NE 139TH ST SUITE 200 VANCOUVER, WA 98686 (360) 487-1777 |
| 1326362021 | MRS. LINDSAY LILLY DPT Individual | Physical Therapist | 2121 NE 139TH ST MOB A, SUITE 200 VANCOUVER, WA 98686 (360) 487-1777 |
| 1265758106 | RACHEL MENNE MS CCC-SLP Individual | Speech-Language Pathologist | 2121 NE 139TH ST MOB SUITE 200 VANCOUVER, WA 98686 (360) 487-1777 |
| 1902102338 | MS. JULIE L AKIN PT Individual | Physical Therapist (Pediatrics) | 2121 NE 139TH ST SUITE 200 VANCOUVER, WA 98686 (360) 487-1777 |
| 1790083590 | ELSA JAYNE DAWSON MS Individual | Speech-Language Pathologist | 2121 NE 139TH ST SUITE 200 VANCOUVER, WA 98686 (360) 487-1777 |
| 1043557283 | MS. BROOKE LYNNE BERARD CCC-SLP Individual | Speech-Language Pathologist | 2121 NE 139TH ST MEDICAL OFFICE BUILDING A, SUITE #200 VANCOUVER, WA 98686 (360) 487-1777 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1063184141, enumerated in the NPI registry as an "organization" on September 28, 2021
The provider is located at 2121 Ne 139th St Bldg 1 Ste 225 Vancouver, Wa 98686 and the phone number is (503) 765-5081
This medical organization specializes in Prosthetic/Orthotic Supplier with taxonomy code 335E00000X
The provider's CLIA number is 50D2033564 for a "physician office" facility with a CLIA Certificate for Provider-Performed Microscopy Procedures (PPMP). This CLIA certificate is issued in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing..
This NPI record was last updated on September 28, 2021. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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