NPIMap

Individual provider Active NPI

Edward Green, MD

  • Diagnostic Radiology Physician
  • Jackson, MS
National Provider Identifier
1073719803
Registry record updated Oct 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
17833 Issued in MS
Practice address
969 Lakeland Dr
Jackson, MS 39216-4606
Phone
(601) 200-6162
NPI assigned
Jun 27, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 6, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 135313 NC
Diagnostic Radiology Physician 2085R0202X 17833 MS Primary

Addresses

Primary practice location

969 Lakeland Dr
Jackson, MS 39216-4606

Mailing address

PO Box 23073
Jackson, MS 39225-3073
Phone (601) 200-6162

Other identifiers 3

IdentifierTypeStateIssuer
512I360002OtherMSPTAN
179024MedicaidAL
P01195515OtherMSRAILROAD MEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080826000630 MS Practitioner - Nuclear Medicine 0648345223 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nuclear Medicine
Education
University of Arkansas College of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lakeland Radiologists P aGroup PAC ID 4183683089, 29 clinicians

Practice addresses (Care Compare)

969 Lakeland Dr
Jackson, MS 39216-4606
Phone (601) 200-2000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.58 of 100Reported as group
Quality
95
Improvement activities
40
Cost
75.31

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
17833MSMDDiagnostic Radiology Physician
135313NCMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
State of Mississippi-University of Mississippi Medical Center CurrentSince Aug 1, 2012 Accepting new patients
State of Mississippi - University of Mississippi Medical Center Current Accepting new patients
Flowood Mississippi Imaging LLC CurrentSince Oct 16, 2024 Accepting new patients
Lakeland Radiologists P a Diagnostic Radiology CurrentSince Jul 1, 2022 Accepting new patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Aug 1, 2012 Accepting new patients
University Radiation Oncology Consultants, PLLC Past Accepting new patients

Locations

965 Avent Dr
Ste 100A
Grenada, MS 38901
Phone (662) 227-7000

2500 N State St
Jackson, MS 39216
Phone (601) 815-4775

969 Lakeland Dr
Jackson, MS 39216
Phone (601) 200-4644

2500 N State St
Rm 5012
Jackson, MS 39216

1815 Hospital Dr
Jackson, MS 39204
Phone (601) 815-4775

239 Bowling Green Rd
Lexington, MS 39095
Phone (662) 834-1321

Organizations & group practices 6

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1182902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665014400000",
    "number": "1073719803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23073",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392253073",
            "telephone_number": "601-200-6162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "969 LAKELAND DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164606",
            "telephone_number": "601-200-6162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "EDWARD",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-27",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "135313",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MS",
            "license": "17833",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "512I360002",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "179024",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PTAN",
            "identifier": "P01195515",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.