Kevin Joseph Green, P.A

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

MA002387-L Issued in PA

Practice address

1450 Scalp Ave
Suite 106
Johnstown, PA 15904-3374

Phone

(814) 266-8466

Fax

(814) 266-0177

NPI assigned

May 23, 2007

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 PA

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

Physician Assistant

State licenses

Practice roles

Locations

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.

• DLP Conemaugh Physician Practices LLC

  • Family Medicine Physician
  • Cresson, PA
  • NPI 1932515905
  Medicare reassignment
• DLP Conemaugh Physician Practices LLC

  • Internal Medicine Physician
  • Johnstown, PA
  • NPI 1144636267

  Physician Assistant

  NPD
• DLP Conemaugh Physician Practices LLC

  • Internal Medicine Physician
  • Johnstown, PA
  • NPI 1205242609

  Physician Assistant

  NPD
• Conemaugh Valley Memorial Hospital

  • Emergency Medicine Physician
  • Johnstown, PA
  • NPI 1346200920
  NPD (past)
• Windber Hospital, Inc.

  • General Acute Care Hospital
  • Windber, PA
  • NPI 1275620536
  NPD (past)

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398384000000",
    "number": "1053521302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 ALVIN ST",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159041833",
            "telephone_number": "814-266-1544",
            "fax_number": "814-266-0177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 SCALP AVE",
            "address_2": "SUITE 106",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159043374",
            "telephone_number": "814-266-8466",
            "fax_number": "814-266-0177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "KEVIN",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "credential": "P.A",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-23",
        "last_updated": "2014-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA002387-L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cory Gray, D.O.
• Deborah Lynn Gray, CRNP
• Greater Johnstown Area Vocational-Technical School
• Greater Johnstown School District
• Joseph A. Green, O.D.
• Richard Joseph Green III, M.D.
• Sara Greenwood, PA-C
• Amy Claire Greer, AU.D.
• George Gress, DMD
• Lori Anne Gress, LPC, NCC

• Physician Assistant in Johnstown, PA
• Providers in Johnstown, PA by specialty
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2014; 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.