Nicole E Green, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

C0007198 Issued in MD

Practice address

500 Upper Chesapeake Dr
Bel Air, MD 21014-4324

Phone

(443) 643-1500

Fax

(443) 643-1505

NPI assigned

Apr 2, 2019

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

Medicare fee-for-service enrollment

Enrolled in MD

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

Specialty

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Agape Physical Therapy and Sports Rehabilitation LPGroup PAC ID 3870741390, 684 clinicians

Upper Chesapeake Orthopedics, LLCGroup PAC ID 4880879162, 11 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Umd Upper Chesapeake Medical Center Hospital, Bel Air, MD, CCN 210049

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ndemaris651577@direct.umm.edu

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.

• Upper Chesapeake Orthopedics, LLC

  • Orthopaedic Surgery Physician
  • Bel Air, MD
  • NPI 1942507629
  Medicare reassignment Care Compare group
• Upper Chesapeake Medical Services, Inc

  • Hospitalist Physician
  • Bel Air, MD
  • NPI 1497801419
  Medicare reassignment
• Agape Physical Therapy & Sports Rehabilitation LP

  • Physical Therapist
  • Forest Hill, MD
  • NPI 1578900668
  Care Compare group
• Upper Chesapeake Orthopedics, LLC

  • Durable Medical Equipment & Medical Supplies
  • Aberdeen, MD
  • NPI 1679443964
  NPD

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

• Upper Chesapeake Medical Center, Inc.

  • General Acute Care Hospital
  • Bel Air, MD
  • NPI 1598761355
  Care Compare affiliation

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

{
    "created_epoch": "1554163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667433600000",
    "number": "1053873786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 UPPER CHESAPEAKE DR",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210144324",
            "telephone_number": "443-643-1500",
            "fax_number": "443-643-1505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 UPPER CHESAPEAKE DR",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210144324",
            "telephone_number": "443-643-1500",
            "fax_number": "443-643-1505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "NICOLE",
        "middle_name": "E",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-02",
        "last_updated": "2022-11-03",
        "certification_date": "2022-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MD",
            "license": "C0007198",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ellen Greaver
• Horace Andrew Greeley
• Carolyn McComas Greely, DNP
• Green Door Family Psychiatry LLC
• Jessica Shante Green, LMSW
• Elizabeth Jane Greeno, PHD, LCSW-C
• Carine Gregory, MD
• Grey Matter Counseling & Consulting, LLC
• Amy Griffin, SLP-CCC
• Nicholas Robert Griffin

• Medical Physician Assistant in Bel Air, MD
• Providers in Bel Air, MD by specialty
• Medical Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2022; 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.