Active NPI
Roosevelt Green, MD
- Pediatrics Physician
- Huntsville, AL
National Provider Identifier
1093729014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 08804
- Practice address
- 751 Pleasant Row NW
Huntsville, AL 35816-2537 - Phone
- (256) 533-6311
- NPI assigned
- Jul 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 08804 | AL | Primary |
Addresses
Primary practice location
751 Pleasant Row NW
Huntsville, AL 35816-2537
Mailing address
PO Box 18488
Huntsville, AL 35804-8488
Phone (256) 534-8659
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 630200045 | Medicaid | AL | |
| 515-05234 | Other | AL | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 08804 | AL | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318550400000",
"number": "1093729014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 18488",
"city": "HUNTSVILLE",
"state": "AL",
"postal_code": "358048488",
"telephone_number": "256-534-8659",
"fax_number": "256-534-0276"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "751 PLEASANT ROW NW",
"city": "HUNTSVILLE",
"state": "AL",
"postal_code": "358162537",
"telephone_number": "256-533-6311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "ROOSEVELT",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-27",
"last_updated": "2011-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "AL",
"license": "08804",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "630200045",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "515-05234",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Huntsville, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.