Active NPI
Kelly M Green, RD
- Registered Dietitian
- Bowie, MD
National Provider Identifier
1013533728
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86109842
- Practice address
- 12201 Stanfield CT
Bowie, MD 20720-4439 - Phone
- (301) 741-9380
- NPI assigned
- Jun 18, 2020
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 86109842 | Primary |
Addresses
Primary practice location
12201 Stanfield CT
Bowie, MD 20720-4439
Mailing address
12201 Stanfield CT
Bowie, MD 20720-4439
Phone (301) 741-9380
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0 | Other | N/A |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | N/A | Other |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230607000837 | MD | Practitioner - Registered Dietitian Or Nutrition Professional | 1850758863 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1592438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1592438400000",
"number": "1013533728",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12201 STANFIELD CT",
"city": "BOWIE",
"state": "MD",
"postal_code": "207204439",
"telephone_number": "301-741-9380"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12201 STANFIELD CT",
"city": "BOWIE",
"state": "MD",
"postal_code": "207204439",
"telephone_number": "301-741-9380"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "KELLY",
"middle_name": "M",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-06-18",
"last_updated": "2020-06-18",
"certification_date": "2020-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": "86109842",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "N/A",
"affiliation": "N",
"endpointDescription": "N/A",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "N/A",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "N/A",
"address_1": "12201 Stanfield Ct",
"city": "Bowie",
"state": "MD",
"country_code": "US",
"postal_code": "207204439",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Bowie, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.