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EVERGREEN PEDIATRIC CLINIC PS
NPI 1144343773
Pediatrics - Adolescent Medicine in Vancouver, WA

Active since April 09, 2007CLIA Certified · 2 labs
505 NE 87TH AVE, STE 120, VANCOUVER, WA 98664(360) 892-1635(360) 892-3146 Get Directions Write a Review

NPPES record last updated: February 21, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Evergreen Pediatric Clinic Ps NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EVERGREEN PEDIATRIC CLINIC PS (NPI 1144343773) is a healthcare organization registered as an adolescent medicine in Vancouver, Washington and active in the NPI registry since April 2007. The organization holds 2 active CLIA laboratory certificates and lists Teri Bryant, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1144343773
Entity TypeOrganization
Primary Taxonomy2080A0000X
Legal Business NameEVERGREEN PEDIATRIC CLINIC PS
Location Address505 NE 87TH AVE, STE 120Vancouver, WA 98664-1989
Mailing Address505 Ne 87th Ave, Ste 120Vancouver, WA 98664-1989 · (360) 892-1635 · Fax (360) 892-3146
Phone(360) 892-1635
Fax(360) 892-3146
Organization SubpartNo
Authorized OfficialTeri BryantOffice Manager · (360) 892-1635
Enumeration DateApril 9, 2007
Last NPPES UpdateFebruary 21, 2020
✔ NPI 1144343773 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatrics · Adolescent MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2080A0000X
License✔ Licensed in WA · 601 115 723
Definition
A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.
505 NE 87TH AVE, Vancouver, WA 98664
Open in Google Maps ↗

Other Identifiers 1

Medicaid7033186WA

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Moda Health Plan, Inc., Providence Health Plan and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 50D0637777

Evergreen Pediatric Clinic · Vancouver, WA
Active · expires Apr 4, 2028
CLIA Number50D0637777
Laboratory TypePhysician Office
Certificate Effective DateSeptember 11, 2015
Certificate Expiration DateApril 4, 2028
Laboratory DirectorSusan Cuneo
Laboratory Phone(360) 892-1635
Laboratory LocationEvergreen Pediatric Clinic505 NE 87th Ave Ste 120, Vancouver, WA 98664
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 50D2033564

Evergreen Pediatric Clinic · Vancouver, WA
Active · expires Apr 4, 2028
CLIA Number50D2033564
Laboratory TypePhysician Office
Certificate Effective DateDecember 6, 2011
Certificate Expiration DateApril 4, 2028
Laboratory DirectorSusan Cuneo
Laboratory Phone(360) 892-1635
Laboratory LocationEvergreen Pediatric Clinic2101 NE 137th Ave Ste 370, Vancouver, WA 98686
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ADAM LOUIS RASKY MD
Ophthalmology
505 NE 87TH AVE, SUITE 100
VANCOUVER, WA 98664
Clark County (360) 904-6781
AIDAN H DERENNE MD
Pediatrics (Adolescent Medicine)
505 NE 87TH AVE, STE 120
VANCOUVER, WA 98664
Clark County (360) 892-1635
CHARLES E FUCHS MD
Pediatrics (Adolescent Medicine)
505 NE 87TH AVE, STE 120
VANCOUVER, WA 98664
Clark County (360) 892-1635
MR. ALAMANDER HICKS PHD
Audiologist
505 NE 87TH AVE, SUITE 150
VANCOUVER, WA 98664
Clark County (360) 892-9367
ERIN P GIBBONS M.D.
Urology
505 NE 87TH AVE, SUITE 200
VANCOUVER, WA 98664
Clark County (360) 256-8836
KATHERINE ELIZABETH HOLLAND M.D.
Pediatrics (Adolescent Medicine)
505 NE 87TH AVE, SUITE 120
VANCOUVER, WA 98664
Clark County (360) 892-1635
JENNIFER L SODEN MD
Pediatrics (Adolescent Medicine)
505 NE 87TH AVE, STE 120
VANCOUVER, WA 98664
Clark County (360) 892-1635
RICHARD A BERNHEIMER JR. MD
Ophthalmology
505 NE 87TH AVE, SUITE 100
VANCOUVER, WA 98664
Clark County (360) 904-6781

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Evergreen Pediatric Clinic Ps's NPI number?

The NPI number for Evergreen Pediatric Clinic Ps is 1144343773. It was assigned to this organization in the NPPES registry on April 9, 2007.

Where is Evergreen Pediatric Clinic Ps located?

Evergreen Pediatric Clinic Ps is located at 505 NE 87th Ave Ste 120, Vancouver, WA 98664. The listed phone number is (360) 892-1635.

What is Evergreen Pediatric Clinic Ps's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Adolescent Medicine, with taxonomy code 2080A0000X.

Does Evergreen Pediatric Clinic Ps hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Evergreen Pediatric Clinic Ps accept?

Health plans from BridgeSpan Health Company, Moda Health Plan, Inc., Providence Health Plan and Regence BlueCross BlueShield of Oregon list Evergreen Pediatric Clinic Ps as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Evergreen Pediatric Clinic Ps was last updated on February 21, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.