Jeff C Green

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

8371309 Issued in OR

Practice address

200 Gwee Shut Rd
Siletz, OR 97380-2036

Phone

(541) 444-9613

NPI assigned

May 25, 2022

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

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: jeff.green.d1.p1@direct.siletzhealthclinic.nextgenshare.com

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

{
    "created_epoch": "1653436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653436800000",
    "number": "1053059352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 GWEE SHUT RD",
            "city": "SILETZ",
            "state": "OR",
            "postal_code": "973802036",
            "telephone_number": "541-444-9613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 GWEE SHUT RD",
            "city": "SILETZ",
            "state": "OR",
            "postal_code": "973802036",
            "telephone_number": "541-444-9613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "JEFF",
        "middle_name": "C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-05-25",
        "last_updated": "2022-05-25",
        "certification_date": "2022-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "OR",
            "license": "8371309",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8989",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "JeffG@ctsi.nsn.us",
            "affiliation": "N",
            "address_1": "200 Gwee Shut Rd",
            "city": "Siletz",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973802036",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Robert John Flores, CRM
• Cassandra Garcia
• Amy Gean Garrett, CHW
• Sandra S Gordon, CADC II
• Autumn Grace Green
• Tamar Karina Hedeshian, DDS
• Angela Ann Henrie
• Deja Ann Herrmann
• Jessie Grow Hodges
• Patricia Diane Jarrett, PMHNP-PP

• Community Health Worker in Siletz, OR
• Providers in Siletz, OR by specialty
• Community Health Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.