Matthew Green

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9118430 Issued in FL

Practice address

2605 Welaunee Blvd
Tallahassee, FL 32308-4697

Phone

(850) 877-8174

Fax

(844) 261-6839

NPI assigned

Oct 3, 2022

Last updated

Feb 13, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL, GA2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tallahassee Orthopedic Clinic III PLGroup PAC ID 4284532755, 538 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• HCA Florida Capital Hospital Hospital, Tallahassee, FL, CCN 100254
• Tallahassee Memorial Healthcare Hospital, Tallahassee, FL, CCN 100135
• Archbold Memorial Hospital Hospital, Thomasville, GA, CCN 110038

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: matthew.green.1@18802.direct.athenahealth.com

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.

• Tallahassee Orthopedic Clinic III PL

  dba Tallahassee Orthopedic Clinic

  • Medical Specialty Clinic/Center
  • Tallahassee, FL
  • NPI 1194778050

  GA

  Medicare reassignment Care Compare group
• Tallahassee Orthopedic Clinic III, P.L.

  • Durable Medical Equipment & Medical Supplies
  • Panama City Beach, FL
  • NPI 1497617948
  NPD
• Hospital Authority of the City of Bainbridge and Decatur County

  dba Memorial Hospital and Manor

  • Multi-Specialty Clinic/Center
  • Bainbridge, GA
  • NPI 1053388256
  NPD (past)

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

• Tallahassee Medical Center Inc

  dba HCA Florida Capital Hospital

  • General Acute Care Hospital
  • Tallahassee, FL
  • NPI 1790732303
  Care Compare affiliation
• Tallahassee Memorial Healthcare Inc

  • General Acute Care Hospital
  • Tallahassee, FL
  • NPI 1437177664
  Care Compare affiliation
• John D Archbold Memorial Hospital Inc

  dba Archbold Memorial

  • General Acute Care Hospital
  • Thomasville, GA
  • NPI 1194779702
  Care Compare affiliation
• John D. Archbold Memorial Hospital, Inc.

  dba John D. Archbold Memorial Hospital - Rehab

  • Rehabilitation Hospital Unit
  • Thomasville, GA
  • NPI 1104867738
  Care Compare affiliation

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

{
    "created_epoch": "1664755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707782400000",
    "number": "1073237962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3334 CAPITAL MEDICAL BLVD STE 400",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084470",
            "telephone_number": "850-877-8174",
            "fax_number": "844-261-6839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2605 WELAUNEE BLVD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084697",
            "telephone_number": "850-877-8174",
            "fax_number": "844-261-6839"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1155 5th St SE",
            "address_purpose": "LOCATION",
            "city": "Cairo",
            "state": "GA",
            "postal_code": "398283142",
            "country_code": "US",
            "telephone_number": "229-226-3060",
            "fax_number": "855-460-8658",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "113 W Hansell St",
            "address_purpose": "LOCATION",
            "city": "Thomasville",
            "state": "GA",
            "postal_code": "317926664",
            "country_code": "US",
            "telephone_number": "229-226-3060",
            "fax_number": "855-460-8658",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3334 Capital Medical Blvd Ste 400",
            "address_purpose": "LOCATION",
            "city": "Tallahassee",
            "state": "FL",
            "postal_code": "323084470",
            "country_code": "US",
            "telephone_number": "850-877-8174",
            "fax_number": "844-261-6839",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREEN",
        "first_name": "MATTHEW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-10-03",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9118430",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003299052A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121259700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jasmine Green
• Jermaine Green Jr., DPT
• John C. Green, M.D.
• Khadija Green
• Latoya Shaquita Green
• Risa Michele Green, P.T.
• Sherri Lucky Green, PA-C
• Tavian Green
• Whitney Green, MEDICAL ASSISTANT
• William Harris Green

• Physician Assistant in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2024; 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.