Jonah Jess Green, MD
Individual provider Active NPI Surgery Physician · Afton, WY
NPI 1013079524 · NPPES record last updated Jul 14, 2016
Key facts
- NPI
- 1013079524
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- 9859A (WY)
- Practice address
- 110 Hospital LN
Afton, WY 83110-9409 - Phone
- (307) 885-5852
- NPI assigned
- Dec 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 20
Hospital & facility affiliations 5
Medicare Care Compare profile
- 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 District
Bear Lake County Memorial Hospital
West Park Hospital District
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
- Star Valley Medical Center
- Bear Lake Memorial Hospital
- Mountain View Hospital
- Cody Regional Health
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Colonoscopy | 1-10 |
| Upper gastrointestinal (GI) endoscopy for acid reflux | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WY, ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140814002261 | WY | Practitioner - General Surgery | 8123029378 | Reassigns benefits to 4 organizations |
| I20161004002635 | ID | Practitioner - General Surgery | 8123029378 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9859A | WY | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cody Regional Health EMS | Current |
Accepting new patients | |
| West Park Hospital District | Current |
Accepting new patients | |
| Bear Lake County Memorial Hospital | Current |
Accepting new patients | |
| West Park Hospital District | Current |
Accepting new patients | |
| Bear Lake County Memorial Hospital | Current |
Accepting new patients | |
| North Lincoln County Hospital District | Current |
Accepting new patients | |
| North Lincoln County Hospital District | Current | Accepting new patients | |
| Ihc Health Services, Inc. | 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
901 Adams St
Afton, WY 83110
Phone (307) 885-5800
110 Hospital Ln
Afton, WY 83110
Phone (208) 227-1137
707 Sheridan Ave
Cody, WY 82414
Phone (307) 527-7561
424 Yellowstone Ave
Ste 120
Cody, WY 82414
Phone (307) 578-2903
Interoperability endpoints
- https://fhir-usa.unify.chbase.com/org/bearlak-58254590
- jgreen642183@direct.ochin.org
- jgreen625984@direct.ochin.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 9859A | WY | Yes |
Addresses
Primary practice location
110 Hospital LN
Afton, WY 83110-9409
Mailing address
110 Hospital LN
Afton, WY 83110-9409
Other providers in Afton, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 14, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.