Individual provider Active NPI

Jessica Green

  • Vascular Surgery Physician
  • Honolulu, HI
National Provider Identifier
1023458700
Registry record updated Oct 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
MD-21050 Issued in HI
Practice address
888 S King St
Honolulu, HI 96813-3097
Phone
(808) 522-4469
NPI assigned
Jun 26, 2013
Last updated
Oct 1, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 1, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X MD-21050 HI Primary

Addresses

Primary practice location

888 S King St
Honolulu, HI 96813-3097

Mailing address

888 S King St
Honolulu, HI 96813-3097
Phone (808) 522-4469

Other practice location 1

303 Parkway Dr NE
Atlanta, GA 30312-1212
Phone (404) 265-4411

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200925002525 HI Practitioner - Vascular Surgery 2860621752 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
Medical College of Georgia School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hawaii Permanente Medical Group IncGroup PAC ID 7618880667, 705 clinicians

Practice addresses (Care Compare)

3288 Moanalua Rd
Honolulu, HI 96819-1469
Phone (808) 432-0000

Merit-based Incentive Payment System (MIPS)

Final score
83.72 of 100Reported as group
Quality
67.55
Promoting interoperability
100
Improvement activities
40
Cost
78.18

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD-21050HIMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Straub Clinic & Hospital CurrentSince Aug 24, 2020 Accepting new patients
Straub Clinic & Hospital Single Specialty CurrentSince Aug 24, 2020 Accepting new patients
Hawaii Permanente Medical Group Inc Single Specialty CurrentSince Mar 11, 2024 Accepting new patients
Straub Clinic & Hospital Past Accepting new patients

Locations

3288 Moanalua Rd
Honolulu, HI 96819
Phone (808) 265-9205

711 Kapiolani Blvd
Honolulu, HI 96813
Phone (808) 432-5312

888 S King St
Honolulu, HI 96813
Phone (808) 522-4000

Interoperability endpoints

  • Direct secure messaging: jessica.green.p189@direct.tenet.nextgenshare.com
  • Direct secure messaging: jessica.green.p53@direct.tenet.nextgenshare.com

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1372204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601510400000",
    "number": "1023458700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "888 S KING ST",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968133097",
            "telephone_number": "808-522-4469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "888 S KING ST",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968133097",
            "telephone_number": "808-522-4469"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "303 Parkway Dr NE",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303121212",
            "country_code": "US",
            "telephone_number": "404-265-4411",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREEN",
        "first_name": "JESSICA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-06-26",
        "last_updated": "2020-10-01",
        "certification_date": "2020-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "HI",
            "license": "MD-21050",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Honolulu, HI

Sources for this page

Verify at the official NPI Registry.