Theodore Green

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP61015452 Issued in WA

Practice address

3716 Pacific Ave Ste E
Tacoma, WA 98418-7836

Phone

(253) 474-5141

NPI assigned

Oct 25, 2019

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 WA

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

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Capital Medical Center Physicians LLCGroup PAC ID 3678639879, 59 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Assured Home Health and Hospice Home health agency, Centralia, WA, CCN 507042
• Providence at Home With Compassus, Puget Sound South Home health agency, Lacey, WA, CCN 507004
• Providence Centralia Hospital Hospital, Centralia, WA, CCN 500019
• Capital Medical Center Hospital, Olympia, WA, CCN 500139

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/FDHGAA

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.

• Capital Medical Center Physicians LLC

  dba Olympia Family Medicine

  • Family Medicine Physician
  • Olympia, WA
  • NPI 1629214283
  Medicare reassignment Care Compare group NPD
• Tumwater Family Practice Clinic

  • Family Medicine Physician
  • Tumwater, WA
  • NPI 1881638559
  Medicare reassignment NPD
• Capital Medical Center Physicians LLC

  dba Montesano Internal Medicine by MultiCare

  • Internal Medicine Physician
  • Montesano, WA
  • NPI 1710744792
  NPD
• Capital Medical Center Physicians LLC

  dba Pioneer Family Practice by MultiCare

  • Family Medicine Physician
  • Lacey, WA
  • NPI 1649037623
  NPD (past)
• Rafael Medicus Clinic, Corp.

  • Family Medicine Physician
  • Lakewood, WA
  • NPI 1558718684
  NPD (past)

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

• CP Sound Wa, LLC

  dba Providence at Home with Compassus Home Health, Puget Sound South

  • Home Health Agency
  • Lacey, WA
  • NPI 1669294708
  Care Compare affiliation
• Multicare Health System

  dba MultiCare Capital Medical Center

  • General Acute Care Hospital
  • Olympia, WA
  • NPI 1841258639
  Care Compare affiliation
• Northwest Healthcare Alliance, Inc.

  dba Assured Home Health & Hospice

  • Home Health Agency
  • Centralia, WA
  • NPI 1154397305
  Care Compare affiliation
• Providence Health & Services Washington

  dba Providence Centralia Hospital

  • General Acute Care Hospital
  • Centralia, WA
  • NPI 1376624981
  Care Compare affiliation

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

{
    "created_epoch": "1571961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616025600000",
    "number": "1053954776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3716 PACIFIC AVE STE E",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984187836",
            "telephone_number": "253-474-5141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3716 PACIFIC AVE STE E",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984187836",
            "telephone_number": "253-474-5141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "THEODORE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-25",
        "last_updated": "2021-03-18",
        "certification_date": "2021-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP61015452",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Lea Green, DSHS INTERPRETER WA
• Rubin David Green, M.D.
• Sabrina E Green
• Sally K Green, RPH
• Tenesha Green, PA-C
• Yolanda M. Green, ARNP
• Charles Greene
• James H. Greene, M.D.
• Krystal M Greene, BA
• Maranda Joy Greene

• Family Nurse Practitioner in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Family Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2021; 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.