Brooks Andrew Green, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12012283A Issued in IN

Practice address

147 E Broad St
Lyons, IN 47443-9502

Phone

(812) 659-2111

NPI assigned

Jun 25, 2015

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Green Dental

  • Dentist
  • Lyons, IN
  • NPI 1134615347
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1435190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435190400000",
    "number": "1003298076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "147 E BROAD ST",
            "city": "LYONS",
            "state": "IN",
            "postal_code": "474439502",
            "telephone_number": "812-659-2111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 E BROAD ST",
            "city": "LYONS",
            "state": "IN",
            "postal_code": "474439502",
            "telephone_number": "812-659-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "BROOKS",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-25",
        "last_updated": "2015-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12012283A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Helene Jacinthe Barrette Bailey, O.T.
• Benjamin Cox
• Elizabeth S. Mateos-Tiongco
• Dorothy Freeman, PTA
• Green Dental
• Gordon Keith Green, DDS
• Stephanie Heinrich, OT
• Laura Jones, PTA
• Linda C Powers, D.D.S., M.S.D
• Scott W Powers, DDS

• All providers in Lyons, IN
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.