Stacey D Green, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

602389 Issued in CA

Practice address

200 UCLA Medical PLZ Ste 120
Los Angeles, CA 90095-1835

Phone

(310) 206-9260

Fax

(310) 794-1649

NPI assigned

Apr 8, 2006

Sex

Female

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

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sgreen58626@direct.uclahealth.org

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.

• Robert P Kahn-Rose, Inc.

  • Specialist
  • Agoura Hills, CA
  • NPI 1407936784
  Medicare reassignment NPD
• The Regents of the University of California

  dba UCLA Dept of Medicine

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1235107566
  Medicare reassignment NPD
• The Regents of the University of California

  dba UCLA Dept of Medicine

  • Ambulatory Surgical Clinic/Center
  • Valencia, CA
  • NPI 1689200305
  NPD
• Los Angeles Hematology-Oncology Medical Group

  • Non-Pharmacy Dispensing Site
  • Glendale, CA
  • NPI 1952516627
  NPD (past)
• Metropolitan Hematology Oncology Medical Group, Inc

  • Hematology & Oncology Physician
  • Los Angeles, CA
  • NPI 1154384758
  NPD (past)

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

{
    "created_epoch": "1144454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577923200000",
    "number": "1053374397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5767 W CENTURY BLVD STE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 UCLA MEDICAL PLZ STE 120",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900951835",
            "telephone_number": "310-206-9260",
            "fax_number": "310-794-1649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "STACEY",
        "middle_name": "D",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-08",
        "last_updated": "2020-01-02",
        "certification_date": "2020-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "602389",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RN602389",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard Dennis Green, DDS
• Richard M. Green, MD
• Sarah B Green, CPNP-AC
• Sebastian Francis Green, MB CHB, MSC
• Shulamite A Green, PH.D.
• Sydney Green
• Takia Green
• Teresa Miriam Green
• Theadore Green, RADT-I
• Wendy L Green, MD

• Nurse Practitioner in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.