Mack Green, MD

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

A1259029 Issued in CA

Practice address

16008 Kamana Rd
Suite 100
Apple Valley, CA 92307-1376

Phone

(760) 956-5200

Fax

(760) 669-0793

NPI assigned

Jun 17, 2010

Sex

Male

Sole proprietor

No

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 CA

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

Specialty

Sports MedicineAlso: Family Practice

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern California Bone and Joint Clinic IncGroup PAC ID 3870771769, 2 clinicians

Barstow Primary Care ClinicGroup PAC ID 7719105774, 6 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Barstow Community Hospital Hospital, Barstow, CA, CCN 050298

Merit-based Incentive Payment System (MIPS)

Final score

95.42 of 100Reported as individual

Quality

84.2

Promoting interoperability

99

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: mack.green.1@8216.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/7705/brand/1/csg/1/fhir/r4

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.

• Barstow Primary Care Clinic

  • Internal Medicine Physician
  • Barstow, CA
  • NPI 1871904656
  Medicare reassignment Care Compare group NPD
• Southern California Bone and Joint Clinic Inc

  • Orthopaedic Surgery Physician
  • Apple Valley, CA
  • NPI 1457670226
  Medicare reassignment Care Compare group NPD
• Bryan a. Gunnoe, MD, Inc.

  • Specialist
  • Hesperia, CA
  • NPI 1487909289
  NPD (past)
• St. Mary Medical Center

  • General Acute Care Hospital
  • Apple Valley, CA
  • NPI 1669456299
  NPD (past)

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

• Hospital of Barstow Inc

  • General Acute Care Hospital
  • Barstow, CA
  • NPI 1780655670
  Care Compare affiliation

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

{
    "created_epoch": "1276732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443398400000",
    "number": "1043531676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12277 APPLE VALLEY RD",
            "address_2": "PMB 288",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923081701",
            "telephone_number": "760-956-5200",
            "fax_number": "760-669-0793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16008 KAMANA RD",
            "address_2": "SUITE 100",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923071376",
            "telephone_number": "760-956-5200",
            "fax_number": "760-669-0793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "MACK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-17",
        "last_updated": "2015-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "CA",
            "license": "A1259029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Green Bridge Living Inc.
• Green Paradise Adult Home Care LLC.
• Green Valley Homehealth Services, Inc
• Green Valley Hospice & Paliative Care Inc
• Jason Green
• Emily Grezenski, OTR/L
• Louise Gricol, MA, CTRS
• Kenneth Grier, M.D.
• Johnisha Michelle Griffin
• Valerie Enriquez Griffis

• Sports Medicine (Family Medicine) Physician in Apple Valley, CA
• Providers in Apple Valley, CA by specialty
• Sports Medicine (Family Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 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.