Phil James Green, PAC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

PA800 Issued in OK

Practice address

1009 W Ferguson Ave
Blackwell, OK 74631-5602

Phone

(580) 363-0052

Fax

(580) 363-0894

NPI assigned

Jun 27, 2005

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 OK

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, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Angels Care Home Health of East Oklahoma Home health agency, Broken Arrow, OK, CCN 377171
• Stillwater Medical-Blackwell Hospital, Blackwell, OK, CCN 370780
• Integris Health Ponca City Hospital, Ponca City, OK, CCN 370006
• Stillwater Medical Center Hospital, Stillwater, OK, CCN 370049

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Green'S Country Clinic, LLC

  • Medical Physician Assistant
  • Blackwell, OK
  • NPI 1093240749

  OK

  Medicare reassignment Authorized official
• Newkirk Rural Health Clinic

  • Family Medicine Physician
  • Newkirk, OK
  • NPI 1073538666

  Family Medicine

  NPD (past)
• Roger Mills County Hospital Authority

  • Family Medicine Physician
  • Cheyenne, OK
  • NPI 1760583942

  Family Medicine

  NPD (past)
• Stillwater Medical Center Authority

  • Rural Acute Care Hospital
  • Blackwell, OK
  • NPI 1104375237
  NPD (past)
• Summit Medical Center

  • General Acute Care Hospital
  • Edmond, OK
  • NPI 1356574560
  NPD (past)
• Triad Complete Healthcare A06 LLC

  • Primary Care Clinic/Center
  • Stillwater, OK
  • NPI 1932809738
  NPD (past)

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

• Five Star Home Health, Inc.

  • Home Health Agency
  • Broken Arrow, OK
  • NPI 1851359194
  Care Compare affiliation
• Integris Health Ponca City Hospital Inc

  • General Acute Care Hospital
  • Ponca City, OK
  • NPI 1548047616

  Hospital

  Care Compare affiliation
• Stillwater Medical Center Authority

  • Rural Acute Care Hospital
  • Blackwell, OK
  • NPI 1104375237

  Hospital

  Care Compare affiliation
• Stillwater Medical Center Authority

  • General Acute Care Hospital
  • Stillwater, OK
  • NPI 1164494027

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1119830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1083610752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1009 W FERGUSON AVE",
            "city": "BLACKWELL",
            "state": "OK",
            "postal_code": "746315602",
            "telephone_number": "580-363-0052",
            "fax_number": "580-363-0894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1009 W FERGUSON AVE",
            "city": "BLACKWELL",
            "state": "OK",
            "postal_code": "746315602",
            "telephone_number": "580-363-0052",
            "fax_number": "580-363-0894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "PHIL",
        "middle_name": "JAMES",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-27",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "PA800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diagnostic Laboratory of Oklahoma LLC
• Jennifer Dinh, DDS
• Caryen Leemarie Fergeson, RPH
• Grand Lake Mental Health Center, Inc.
• Grand Lake Mental Health Center, Inc.
• Green'S Country Clinic, LLC
• Samuel Lyle Hague, MD
• Eric Scott Hammack, DDS
• Shane Micheal Hardemon
• Ladonna Fern Haven

• All providers in Blackwell, OK
• Family Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.