Individual provider Active NPI

Tanner James Green

  • Physician Assistant
  • Simi Valley, CA
National Provider Identifier
1093473647
Registry record updated Mar 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
60441 Issued in CA
Practice address
2975 Sycamore Dr
Simi Valley, CA 93065-1201
Phone
(805) 955-6107
NPI assigned
Dec 1, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 60441 CA Primary

Addresses

Primary practice location

2975 Sycamore Dr
Simi Valley, CA 93065-1201

Mailing address

1203 Flynn Rd Unit 160
Camarillo, CA 93012-6203
Phone (805) 804-4168

Other practice location 1

137 E Thousand Oaks Blvd
Thousand Oaks, CA 91360-5707
Phone (805) 379-4574

Other practice location 2

2525 Erringer Rd
Simi Valley, CA 93065-2352
Phone (805) 527-1404

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20220127002373 CA Practitioner - Physician Assistant 7517359342 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ventura Orthopedics Medical Group IncGroup PAC ID 2062312911, 79 clinicians
Synergy Observation Specialists PCGroup PAC ID 5496138307, 34 clinicians
Southern California Permanente Medical GroupGroup PAC ID 6002729175, 11,250 clinicians

Practice addresses (Care Compare)

2525 Erringer Rd
Simi Valley, CA 93065-2352
Phone (805) 527-1404

2975 Sycamore Dr
Simi Valley, CA 93065-1201
Phone (805) 955-6000

4949 Market St
Ventura, CA 93003-7851
Phone (877) 608-0044

5601 De Soto Ave
Woodland Hills, CA 91367-6701
Phone (818) 719-2000

888 S Hill Rd
Ventura, CA 93003-8400
Phone (805) 477-6400

Hospital & facility affiliations

  • Adventist Health Simi Valley Hospital, Simi Valley, CA, CCN 050236

Merit-based Incentive Payment System (MIPS)

Final score
96.69 of 100Reported as group
Quality
90
Improvement activities
40
Cost
78.43

Merit-based Incentive Payment System (MIPS)

Final score
84.94 of 100Reported as group
Quality
73.38
Improvement activities
40
Cost
72.82

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
60441CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince May 5, 2024 Accepting new patients
Cep America - California CurrentSince Jan 1, 2022 Accepting new patients
Southern California Permanente Medical Group CurrentSince May 5, 2024 Accepting new patients

Locations

751 Medical Center Ct
#1182
Chula Vista, CA 91911

13652 Cantara St
Panorama City, CA 91402
Phone (818) 375-2417

393 E Walnut St
Fl 5
Pasadena, CA 91188
Phone (310) 403-3235

15031 Rinaldi St
San Fernando, CA 91345
Phone (818) 365-8051

888 S Hill Rd
Ventura, CA 93003
Phone (805) 477-6400

5601 De Soto Ave
Woodland Hls, CA 91367
Phone (818) 719-2000

Organizations & group practices 8

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.

Hospital & facility affiliations 1

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": "1638316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774569600000",
    "number": "1093473647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1203 FLYNN RD UNIT 160",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930126203",
            "telephone_number": "805-804-4168",
            "fax_number": "805-830-1177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2975 SYCAMORE DR",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930651201",
            "telephone_number": "805-955-6107"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "137 E Thousand Oaks Blvd",
            "address_purpose": "LOCATION",
            "city": "Thousand Oaks",
            "state": "CA",
            "postal_code": "913605707",
            "country_code": "US",
            "telephone_number": "805-379-4574",
            "fax_number": "805-379-4324",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2525 Erringer Rd",
            "address_purpose": "LOCATION",
            "city": "Simi Valley",
            "state": "CA",
            "postal_code": "930652352",
            "country_code": "US",
            "telephone_number": "805-527-1404",
            "fax_number": "805-527-5246",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREEN",
        "first_name": "TANNER",
        "middle_name": "JAMES",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-12-01",
        "last_updated": "2026-03-27",
        "certification_date": "2026-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "60441",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "13652 Cantara St",
            "city": "Panorama City",
            "state": "CA",
            "country_code": "US",
            "postal_code": "914025423",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Simi Valley, CA

Sources for this page

Verify at the official NPI Registry.