Active NPI
Rebecca A Green, DC, DACBSP
- Sports Physician Chiropractor
- Colchester, CT
National Provider Identifier
1013106046
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Physician Chiropractor
- License
- 001023
- Practice address
- 121 Broadway St
Suite 2
Colchester, CT 06415-1052 - Phone
- (860) 537-8900
- Fax
- (860) 537-8868
- NPI assigned
- Oct 16, 2007
- Last updated
- Oct 16, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Physician Chiropractor | 111NS0005X | 001023 | CT | Primary |
Addresses
Primary practice location
121 Broadway St
Suite 2
Colchester, CT 06415-1052
Mailing address
PO Box 1632
Middletown, CT 06457-8132
Phone (860) 537-8900
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 050001023CT04 | Other | CT | ANTHEM BCBS |
| CT01023 | Other | CT | HEALTH NET |
| 3984974 | Other | CT | AETNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1023 | CT | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr Rebecca Green | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Chiropractor
- Colchester, CT
- NPI 1477614519
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1192492800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192492800000",
"number": "1013106046",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1632",
"city": "MIDDLETOWN",
"state": "CT",
"postal_code": "064578132",
"telephone_number": "860-537-8900",
"fax_number": "860-537-8868"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "121 BROADWAY ST",
"address_2": "SUITE 2",
"city": "COLCHESTER",
"state": "CT",
"postal_code": "064151052",
"telephone_number": "860-537-8900",
"fax_number": "860-537-8868"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "REBECCA",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "DC, DACBSP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-10-16",
"last_updated": "2007-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "111NS0005X",
"taxonomy_group": "",
"desc": "Chiropractor, Sports Physician",
"state": "CT",
"license": "001023",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS",
"identifier": "050001023CT04",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH NET",
"identifier": "CT01023",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "3984974",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Colchester, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.