EVERGREEN FAMILY MEDICINE, PC – Family Medicine Physician, NPI 1417929050
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for EVERGREEN FAMILY MEDICINE, PC
1937 W Harvard Ave
Roseburg, OR 974712720
Phone: (541) 677-7200
Type: Location
2570, Northwest Edenbower Boulevard, Roseburg, Douglas County, Oregon, 97471, United States
STE 100
ROSEBURG, OR 974706214
Phone: (541) 229-3301
Fax: (541) 677-7462
Type: Mailing
Northwest Edenbower Boulevard, Roseburg, Douglas County, Oregon, 97470, United States
ROSEBURG, OR 974716214
Phone: (541) 229-3301
Fax: (541) 677-7462
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-03-30
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20040330000219 | O | Clinic/Group Practice | OR | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 97471)
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