NPIMap

Individual provider Active NPI

Jonah Jess Green, MD

  • Surgery Physician
  • Afton, WY
National Provider Identifier
1013079524
Registry record updated Jul 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
9859A Issued in WY
Practice address
110 Hospital LN
Afton, WY 83110-9409
Phone
(307) 885-5852
NPI assigned
Dec 14, 2006
Last updated
Jul 14, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 14, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 9859A WY Primary

Addresses

Primary practice location

110 Hospital LN
Afton, WY 83110-9409

Mailing address

110 Hospital LN
Afton, WY 83110-9409

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY, ID2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140814002261 WY Practitioner - General Surgery 8123029378 Reassigns benefits to 4 organizations
I20161004002635 ID Practitioner - General Surgery 8123029378 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Medical College of Wisconsin, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Lincoln County Hospital DistrictGroup PAC ID 4789580218, shared by 4 NPIs, 66 clinicians
West Park Hospital DistrictGroup PAC ID 7315855624, 85 clinicians

Practice addresses (Care Compare)

110 Hospital LN
Afton, WY 83110-9409
Phone (307) 885-5852

164 S
Montpelier, ID 83254-1557

164 S 5TH St
Montpelier, ID 83254-1557

166 S 5TH St
Montpelier, ID 83254-1557
Phone (208) 847-1110

424 Yellowstone Ave
Suite 120
Cody, WY 82414-9311
Phone (307) 578-2903

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
9859AWYMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bear Lake County Memorial Hospital CurrentSince Apr 23, 2022 Accepting new patients
North Lincoln County Hospital District Current Accepting new patients
Cody Regional Health EMS CurrentSince Jun 1, 2015 Accepting new patients
Bear Lake County Memorial Hospital CurrentSince Apr 23, 2022 Accepting new patients
West Park Hospital District CurrentSince Jun 1, 2015 Accepting new patients
North Lincoln County Hospital District CurrentSince Aug 1, 2014 Accepting new patients
West Park Hospital District CurrentSince Jun 1, 2015 Accepting new patients
Ihc Health Services, Inc. Past Accepting new patients
Bear Lake County Memorial Hospital Past Accepting new patients

Locations

164 S 5th St
Montpelier, ID 83254
Phone (208) 847-1630

166 S 5th St
Montpelier, ID 83254
Phone (208) 847-1110

110 Hospital Ln
Afton, WY 83110
Phone (208) 227-1137

901 Adams St
Afton, WY 83110
Phone (307) 885-5800

424 Yellowstone Ave
Ste 120
Cody, WY 82414
Phone (307) 578-2903

707 Sheridan Ave
Cody, WY 82414
Phone (307) 527-7561

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/bearlak-58254590
  • Direct secure messaging: jgreen625984@direct.ochin.org
  • Direct secure messaging: jgreen642183@direct.ochin.org

Organizations & group practices 9

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

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468454400000",
    "number": "1013079524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 HOSPITAL LN",
            "city": "AFTON",
            "state": "WY",
            "postal_code": "831109409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 HOSPITAL LN",
            "city": "AFTON",
            "state": "WY",
            "postal_code": "831109409",
            "telephone_number": "307-885-5852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "JONAH",
        "middle_name": "JESS",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-14",
        "last_updated": "2016-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WY",
            "license": "9859A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Afton, WY

Sources for this page

Verify at the official NPI Registry.