EVERGREEN DERMATOPATHOLOGY PLLC
NPI 1700581170
Pathology - Dermatopathology in Liberty Lake, WA
NPI Status: Active since April 04, 2023
Contact Information
2110 N MOLTER RD #112
LIBERTY LAKE, WA
ZIP 99019
Phone: (208) 277-9704
Fax: (208) 277-9704
NPPES record last updated: April 4, 2023. Verified against the NPPES registry weekly; last sync: July 12, 2026.
- Organization
- Pathology
- Dermatopathology
- Accepts Insurance
- CLIA Number: 50D2281860
- CLIA Cert. Type: Independent
- CLIA Exp. Date: 04-04-2028
About EVERGREEN DERMATOPATHOLOGY PLLC
This page provides the complete NPI Profile along with additional information for Evergreen Dermatopathology Pllc, a provider established in Liberty Lake, Washington operating as a Pathology, focusing in dermatopathology . The healthcare provider is registered in the NPI registry with number 1700581170 assigned on April 2023. The practitioner's primary taxonomy code is 207ZD0900X. The provider is registered as an organization and their NPI record was last updated 3 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 Ashley Anne Hamstra Md (Practice Owner)
- NPI
- 1700581170
- Provider Name
- EVERGREEN DERMATOPATHOLOGY PLLC
- Entity Type
- Organization
- Location Address
- 2110 N MOLTER RD #112 LIBERTY LAKE, WA 99019
- Location Phone
- (208) 277-9704
- Location Fax
- (208) 277-9704
- Mailing Address
- 2110 N MOLTER RD #112 LIBERTY LAKE, WA 99019
- Mailing Phone
- (208) 277-9704
- Mailing Fax
- (208) 277-9704
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 04-04-2023
- Last Update Date
- 04-04-2023
- Code Navigator
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
Pathology Dermatopathology
- Taxonomy Code
- 207ZD0900X
- Type
- Allopathic & Osteopathic Physicians
- Taxonomy Description
- A dermatopathologist is an expert in diagnosing and monitoring diseases of the skin including infectious, immunologic, degenerative, and neoplastic diseases. This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings, and smears of skin lesions by means of light microscopy, electron microscopy, and fluorescence microscopy.
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:
- 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
- Moda Health Oregon Standard Bronze Affinity - EPO
- Moda Health Oregon Standard Gold Affinity - EPO
- Moda Health Oregon Standard Silver Affinity - EPO
- Moda Select Alaska Bronze 6500 - PPO
- Moda Select Alaska Bronze HDHP 5500 - PPO
- Moda Select Alaska Gold 1500 - PPO
- Moda Select Alaska Silver 4500 - PPO
- Moda Select Alaska Standard Bronze - PPO
- Moda Select Alaska Standard Gold - PPO
- Moda Select Alaska Standard Silver - PPO
- Premera Blue Cross Alaska One Gold - PPO
- Premera Blue Cross Preferred Bronze 5800 HSA - PPO
- Premera Blue Cross Preferred Bronze 6350 - PPO
- Premera Blue Cross Preferred Gold 1500 - PPO
- Premera Blue Cross Preferred Silver 4500 - PPO
- Premera Blue Cross Standard Bronze II - PPO
- Premera Blue Cross Standard Gold - PPO
- Premera Blue Cross Standard Silver - PPO
- Premera Blue Cross Family Dental - PPO
- Premera Blue Cross Pediatric Dental - PPO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
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
- 50D2281860
- Facility Type
- Independent
- Certificate Effective Date
- May 12, 2023
- Certificate Expiration Date
- April 04, 2028
- Laboratory Director
- ASHLEY HAMSTRA
- Certificate Type
- Certificate of Compliance
- Certificate Type Description
- This CLIA certificate is issued to Evergreen Dermatopathology Pllc after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing.
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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 1700581170, we treat the final digit (0) 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 50. The final step is to find the difference between that total and the next multiple of ten (50 - 50 = 0).
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 50 is 50. The difference is the calculated check digit.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1700581170, enumerated as an "organization" on April 04, 2023.
The provider is located at 2110 N MOLTER RD #112 LIBERTY LAKE, WA 99019 and the phone number is (208) 277-9704.
Pathology with taxonomy code 207ZD0900X and a focus in Dermatopathology.
The provider might be accepting Accepts: Moda Health Plan, Inc. and Premera Blue Cross Blue. Please consult your insurance carrier or call the provider to verify.
