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EVERGREEN OCULOFACIAL PLASTIC SURGERY LLC
NPI 1669133492
Ophthalmology - Ophthalmic Plastic and Reconstructive Surgery in Bend, OR

Active since January 04, 2022
929 SW SIMPSON AVE STE 250, BEND, OR 97702(541) 585-0505 Get Directions Write a Review

NPPES record last updated: March 20, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Oct 17, 2023, Jan 4, 2022 (2 updates tracked since 2022).

About Evergreen Oculofacial Plastic Surgery Llc NPPES

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

EVERGREEN OCULOFACIAL PLASTIC SURGERY LLC (NPI 1669133492) is a healthcare organization registered as an ophthalmic plastic and reconstructive surgery in Bend, Oregon and active in the NPI registry since January 2022. The organization maintains a secondary practice location in Grand Junction and lists Tara Marie Goecks, Owner, as its authorized official.

NPPES Registry Identity

NPI1669133492
Entity TypeOrganization
Primary Taxonomy207WX0200X
Legal Business NameEVERGREEN OCULOFACIAL PLASTIC SURGERY LLC
Location Address929 SW SIMPSON AVE STE 250Bend, OR 97702-3599
Mailing AddressPo Box 6387Bend, OR 97708-6387
Phone(541) 585-0505
Organization SubpartNo
Authorized OfficialTara Marie GoecksOwner · (303) 228-3220
Enumeration DateJanuary 4, 2022
Last NPPES UpdateMarch 20, 20242 updates tracked since enumeration
NPPES CertifiedMarch 20, 2024
✔ NPI 1669133492 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOphthalmology · Ophthalmic Plastic and Reconstructive SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code207WX0200X
Definition
A physician who specializes in oculofacial plastic and reconstructive surgery. This subspecialty combines orbital and periocular surgery with facial plastic surgery, and includes aesthetic and reconstructive surgery of the face, orbit, eyelid, and lacrimal system. Practitioners evaluate, diagnose and treat conditions involving the eyelids, brows, midface, orbits, lacrimal systems and surrounding and supporting structures of the face and neck.
929 SW SIMPSON AVE STE 250, Bend, OR 97702
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Secondary Practice Location 1

Location 11190 Bookcliff Ave Unit 102Grand Junction, CO 81501-8159 · Phone (303) 228-3220

Other Identifiers 1

Other1598051732CO · Anthem

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 Moda Health Plan, Inc..Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Evergreen Oculofacial Plastic Surgery Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by March 31, 2027

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateColoradoEnrollment IDO20220209000620Non-DME Part B · Clinic/Group PracticeDue dateMarch 31, 2027
Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Evergreen Oculofacial Plastic Surgery LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Tara Goecks, MD
Ophthalmology
NPI 1598051732
929 SW SIMPSON AVE STE 250
Bend, OR 97702
(541) 585-0505
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Oculofacial Plastic Surgery LLC's NPI number?

The NPI number for Evergreen Oculofacial Plastic Surgery LLC is 1669133492. It was assigned to this organization in the NPPES registry on January 4, 2022.

Where is Evergreen Oculofacial Plastic Surgery LLC located?

Evergreen Oculofacial Plastic Surgery LLC is located at 929 SW Simpson Ave Ste 250, Bend, OR 97702. The listed phone number is (541) 585-0505.

What is Evergreen Oculofacial Plastic Surgery LLC's specialty?

The primary specialty registered for this NPI is Ophthalmology, specializing in Ophthalmic Plastic and Reconstructive Surgery, with taxonomy code 207WX0200X.

Is Evergreen Oculofacial Plastic Surgery LLC enrolled in Medicare?

Yes. Evergreen Oculofacial Plastic Surgery LLC is registered in the Medicare PECOS enrollment system.

When is Evergreen Oculofacial Plastic Surgery LLC's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Colorado, Clinic/Group Practice) is due for revalidation by March 31, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

How many clinicians bill Medicare through Evergreen Oculofacial Plastic Surgery LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Ophthalmology) reassigns their Medicare billing to Evergreen Oculofacial Plastic Surgery LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Evergreen Oculofacial Plastic Surgery LLC accept?

Health plans from Moda Health Plan, Inc. list Evergreen Oculofacial Plastic Surgery LLC 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 Oculofacial Plastic Surgery LLC was last updated on March 20, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.