Mark Stephen Green, PH.D., L.P.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

2354 Issued in KS

Practice address

9415 E Harry St
Suite 703
Wichita, KS 67207-5089

Phone

(316) 978-6102

NPI assigned

Sep 26, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pratt Regional Medical Center CorporationGroup PAC ID 1355253238, 37 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mark.green.1@14930.direct.athenahealth.com

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.

• Pratt Regional Medical Center Corporation

  • Rural Acute Care Hospital
  • Pratt, KS
  • NPI 1578596904
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1443225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443225600000",
    "number": "1033589569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1845 FAIRMOUNT ST",
            "address_2": "BOX 91",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672600091",
            "telephone_number": "316-978-6102",
            "fax_number": "316-978-3216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9415 E HARRY ST",
            "address_2": "SUITE 703",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672075089",
            "telephone_number": "316-978-6102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "MARK",
        "middle_name": "STEPHEN",
        "name_prefix": "Dr.",
        "credential": "PH.D., L.P.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-09-26",
        "last_updated": "2015-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "KS",
            "license": "2354",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeanetta Faye Green
• Keyonia Green
• Kimerly Ann Green, COTA/L
• Kristen Jessica Green, COTA
• Kynsha L'Keyia Green
• Rebecca L Green, M.D.
• Ashleigh Heather Greene, TLMFT
• August Danielle Greene
• Mindy Lynn Greene, LMSW
• Shane Greene, LPN

• Psychologist in Wichita, KS
• Providers in Wichita, KS by specialty
• Psychologist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2015; 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.