NPIMap

Individual provider Active NPI

Nolan Tyler Green, DO

  • Family Medicine Physician
  • Waseca, MN
National Provider Identifier
1033739297
Registry record updated Aug 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
70677 Issued in MN
Practice address
501 State St N
Waseca, MN 56093-2811
Phone
(507) 835-1210
NPI assigned
Apr 17, 2020
Last updated
Aug 16, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 16, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 70677 MN Primary

Addresses

Primary practice location

501 State St N
Waseca, MN 56093-2811

Mailing address

501 State St N
Waseca, MN 56093-2811
Phone (507) 835-1210

Other practice location 1

101 Martin Luther King Dr
Mankato, MN 56001-6460
Phone (507) 594-6572

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ngreen628726@ehrdirect.mayoclinicmsg.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221123000063 MN Practitioner - Family Practice 1052732633 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
West Virginia School of Osteopathic Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mayo Clinic Health System-Southwest Minnesota RegionGroup PAC ID 4688585771, shared by 6 NPIs, 658 clinicians

Practice addresses (Care Compare)

101 Martin Luther King Dr
Jr
Mankato, MN 56001-6460
Phone (507) 385-6500

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
70677MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Health System-St James CurrentSince Jan 24, 2025 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region CurrentSince Dec 1, 2022 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region Current Accepting new patients
Mayo Clinic Health System-St James Current Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region Current Accepting new patients

Locations

404 W Fountain St
Albert Lea, MN 56007
Phone (507) 377-6285

1000 1st Dr NW
Austin, MN 55912
Phone (507) 433-7351

32021 County 24 Blvd
Cannon Falls, MN 55009
Phone (507) 263-6000

800 Medical Center Dr
Fairmont, MN 56031
Phone (507) 238-8100

500 W Grant St
Lake City, MN 55041
Phone (651) 345-3321

101 Martin Luther King Dr
Mankato, MN 56001
Phone (507) 385-6500

1025 Marsh St
Mankato, MN 56001
Phone (507) 345-2623

301 2nd St NE
New Prague, MN 56071
Phone (952) 758-4431

1101 Moulton and Parsons Dr
Saint James, MN 56081
Phone (507) 375-3261

501 State St N
Waseca, MN 56093
Phone (507) 835-1210

Interoperability endpoints

  • Direct secure messaging: ngreen628726@ehrdirect.mayoclinicmsg.org

Organizations & group practices 5

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1587081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692144000000",
    "number": "1033739297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 STATE ST N",
            "city": "WASECA",
            "state": "MN",
            "postal_code": "560932811",
            "telephone_number": "507-835-1210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 STATE ST N",
            "city": "WASECA",
            "state": "MN",
            "postal_code": "560932811",
            "telephone_number": "507-835-1210"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 Martin Luther King Dr",
            "address_purpose": "LOCATION",
            "city": "Mankato",
            "state": "MN",
            "postal_code": "560016460",
            "country_code": "US",
            "telephone_number": "507-594-6572",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREEN",
        "first_name": "NOLAN",
        "middle_name": "TYLER",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-04-17",
        "last_updated": "2023-08-16",
        "certification_date": "2023-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "70677",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ngreen628726@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "501 State St N",
            "city": "Waseca",
            "state": "MN",
            "country_code": "US",
            "postal_code": "560932811",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Waseca, MN

Sources for this page

Verify at the official NPI Registry.