EVERGREEN PEDIATRIC CLINIC PS
NPI 1144343773
Pediatrics - Adolescent Medicine in Vancouver, WA
NPI Status: Active since April 09, 2007
Contact Information
505 NE 87TH AVE
STE 120
VANCOUVER, WA
ZIP 98664
Phone: (360) 892-1635
Fax: (360) 892-3146
- Organization
- Pediatrics
- Adolescent Medicine
- Accepts Insurance
- CLIA Number: 50D2033564
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 04-04-2028
About EVERGREEN PEDIATRIC CLINIC PS
This page provides the complete NPI Profile along with additional information for Evergreen Pediatric Clinic Ps, a pediatrician established in Vancouver, Washington operating as a Pediatrics, focusing in adolescent medicine . The healthcare provider is registered in the NPI registry with number 1144343773 assigned on April 2007. The practitioner's primary taxonomy code is 2080A0000X with license number 601 115 723 (WA). The provider is registered as an organization and their NPI record was last updated 6 years ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The authorized official of this NPI record is Teri Bryant (Office Manager)
- NPI
- 1144343773
- Provider Name
- EVERGREEN PEDIATRIC CLINIC PS
- Entity Type
- Organization
- Location Address
- 505 NE 87TH AVE STE 120 VANCOUVER, WA 98664
- Location Phone
- (360) 892-1635
- Location Fax
- (360) 892-3146
- Mailing Address
- 505 NE 87TH AVE STE 120 VANCOUVER, WA 98664
- Mailing Phone
- (360) 892-1635
- Mailing Fax
- (360) 892-3146
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 04-09-2007
- Last Update Date
- 02-21-2020
- Code Navigator
A pediatrician like Evergreen Pediatric Clinic Ps is a physician who has completed a pediatric residency and is board-certified or board-eligible in a pediatric specialty. Pediatric care providers are trained to care for newborns, infants, children and adolescents. A pediatrician could perform physical exams, manage vaccinations, monitor development milestones, diagnose illnesses, infections, injuries or other health problems, etc.
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
Pediatrics Adolescent Medicine
- Taxonomy Code
- 2080A0000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 601 115 723
- License State
- WA
- Taxonomy Description
- 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.
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- BridgeSpan Standard Bronze Plan - EPO
- BridgeSpan Standard Gold Plan - EPO
- BridgeSpan Standard Silver Plan - EPO
- Moda Health Affinity Bronze 8000 - EPO
- Moda Health Affinity Bronze 9000 - EPO
- Moda Health Affinity Bronze HDHP 7500 - EPO
- Moda Health Affinity Gold 1000 - EPO
- Moda Health Affinity Gold 1500 - EPO
- Moda Health Affinity Gold 250 - EPO
- Moda Health Affinity Silver 3000 - EPO
- Moda Health Affinity Silver 3400 - EPO
- Moda Health Affinity Silver 4500 - EPO
- Moda Health Affinity Silver 6000 - EPO
- HSA Qualified 7500 Bronze - Choice Network - EPO
- HSA-E Qualified 7500 Bronze - Signature Network - EPO
- Providence Oregon Standard Bronze Plan - Choice Network - EPO
- Providence Oregon Standard Bronze Plan - Signature Network - EPO
- Providence Oregon Standard Gold Plan - Choice Network - EPO
- Providence Oregon Standard Gold Plan - Signature Network - EPO
- Providence Oregon Standard Silver Plan - Choice Network - EPO
- Providence Oregon Standard Silver Plan - Signature Network - EPO
- Bronze Essential 9000 With 4 Copay No Deductible Office Visits Individual Connect - EPO
- Bronze Essential 9000 With 4 Copay No Deductible Office Visits Legacy - EPO
- Bronze HSA 7000 Individual Connect - EPO
- Gold 2300 Individual Connect - EPO
- Gold 2300 Legacy - EPO
- Regence Standard Bronze Plan Individual Connect - EPO
- Regence Standard Bronze Plan Legacy - EPO
- Regence Standard Gold Plan Individual Connect - EPO
- Regence Standard Gold Plan Legacy - EPO
- Regence Standard Silver Plan Individual Connect - EPO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 7033186 | MEDICAID (05) | WA |
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 Pediatric Clinic Ps 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 NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1144343773, we treat the final digit (3) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 67. The final step is to find the difference between that total and the next multiple of ten (70 - 67 = 3).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 67 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 20 providers are registered at the same or a nearby location.
VANCOUVER, WA 98664
VANCOUVER, WA 98664
VANCOUVER, WA 98664
VANCOUVER, WA 98664
VANCOUVER, WA 98664
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1144343773, enumerated as an "organization" on April 09, 2007.
The provider is located at 505 NE 87TH AVE STE 120 VANCOUVER, WA 98664 and the phone number is (360) 892-1635.
Pediatrics with taxonomy code 2080A0000X and a focus in Adolescent Medicine.
The provider might be accepting Accepts: BridgeSpan Health Company, Moda Health Plan, Inc.,. Please consult your insurance carrier or call the provider to verify.
