Nicole A Green, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

71004197A Issued in IN

Practice address

3800 St Mary Dr
Suite 103
Valparaiso, IN 46383-7502

Phone

(219) 464-2123

Fax

(219) 465-0032

NPI assigned

Oct 2, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ngreen8982@ssdirect.comhs.org

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.

• Community Care Network Inc

  • Family Medicine Physician
  • St John, IN
  • NPI 1457610487

  IN

  Medicare reassignment Care Compare group NPD

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

• Community Stroke and Rehabilitation Center Inc

  • Rehabilitation Hospital
  • Crown Point, IN
  • NPI 1801301437

  Inpatient rehabilitation facility

  Care Compare affiliation
• Porter Hospital LLC

  • General Acute Care Hospital
  • Valparaiso, IN
  • NPI 1215151154

  Hospital

  Care Compare affiliation
• St Catherine Hospital Inc

  • General Acute Care Hospital
  • East Chicago, IN
  • NPI 1689776882

  Hospital

  Care Compare affiliation
• St Mary Medical Center Inc

  • General Acute Care Hospital
  • Hobart, IN
  • NPI 1558463745

  Hospital

  Care Compare affiliation
• St Mary Medical Center Inc

  • General Acute Care Hospital
  • Hobart, IN
  • NPI 1962504175

  Hospital

  Care Compare affiliation

Specialty

Nurse Practitioner

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Community Care Network Inc 378 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Mary Medical Center Inc Hospital, Hobart, IN, CCN 150034
• St Catherine Hospital Inc Hospital, East Chicago, IN, CCN 150008
• Northwest Health - Porter Hospital, Valparaiso, IN, CCN 150035
• Powers Health Rehabilitation Center Inpatient rehabilitation facility, Crown Point, IN, CCN 153045

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

{
    "created_epoch": "1349136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359590400000",
    "number": "1013268929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3800 ST MARY DR",
            "address_2": "SUITE 103",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463837502",
            "telephone_number": "219-464-2123",
            "fax_number": "219-465-0032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 ST MARY DR",
            "address_2": "SUITE 103",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463837502",
            "telephone_number": "219-464-2123",
            "fax_number": "219-465-0032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "NICOLE",
        "middle_name": "A",
        "name_prefix": "Miss",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-02",
        "last_updated": "2013-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IN",
            "license": "28171988A",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71004197A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jordan Gray, PTA
• Melissa Grcich, FNP-C
• Great Lakes at Home Care, Inc.
• Great Lakes Labs, LLC
• Green Oaks of Valparaiso, LLC
• Michelle Dincecco Greenawald, MOT
• Janet Ann Greer
• Savannah Griffin
• Rebecca Gronski, PTA
• Irene M Grosdanis, LCSW

• All providers in Valparaiso, IN
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2013; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.