Individual provider Active NPI

Ben Nmi Green, PHD

  • Clinical Psychologist
  • Madison, WI
National Provider Identifier
1104882927
Registry record updated Jan 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
1639-57 Issued in WI
Practice address
7617 Mineral Point Rd
Ste 300
Madison, WI 53717-1623
Phone
(608) 833-9290
Fax
(608) 833-9691
NPI assigned
Apr 21, 2006
Last updated
Jan 19, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 31440-020 WI
Clinical Psychologist 103TC0700X 1639-57 WI Primary

Addresses

Primary practice location

7617 Mineral Point Rd
Ste 300
Madison, WI 53717-1623

Mailing address

7617 Mineral Point Rd
Ste 300
Madison, WI 53717-1623
Phone (608) 833-9290

Other identifiers 1

IdentifierTypeStateIssuer
39088700MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1639-57WIMDClinical Psychologist
31440-020WIMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
The Psychology Center S C CurrentSince Feb 1, 2003 Accepting new patients
Affiliated Counseling Center, Inc PastSince Jun 1, 2013 Accepting new patients

Locations

7617 Mineral Point Rd
Madison, WI 53717
Phone (608) 833-9290

7617 Mineral Point Rd
Ste 300
Madison, WI 53717
Phone (608) 833-9290

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295395200000",
    "number": "1104882927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7617 MINERAL POINT RD",
            "address_2": "STE 300",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537171623",
            "telephone_number": "608-833-9290",
            "fax_number": "608-833-9691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7617 MINERAL POINT RD",
            "address_2": "STE 300",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537171623",
            "telephone_number": "608-833-9290",
            "fax_number": "608-833-9691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "BEN",
        "middle_name": "NMI",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-21",
        "last_updated": "2011-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "31440-020",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "1639-57",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39088700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.