NPIMap

Organization Active NPI

Walter S Green MD Medical Corporation

  • Specialist
  • San Clemente, CA
National Provider Identifier
1114120243
Registry record updated Jan 10, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
A09766 Issued in CA
Legal business name
WALTER S GREEN MD MEDICAL CORPORATION
Practice address
657 Camino de Los Mares Ste 242
San Clemente, CA 92673-2811
Phone
(949) 496-6066
NPI assigned
Jun 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2009

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

Authorized official

Name
Dr. Walter S Green, M.D.
Title
Medical Doctor
Phone
(949) 496-6066

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X A09766 CA Primary

Addresses

Primary practice location

657 Camino de Los Mares Ste 242
San Clemente, CA 92673-2811

Mailing address

657 Camino de Los Mares Ste 242
San Clemente, CA 92673-2811
Phone (949) 496-6066

National Provider Directory

National Provider Directory
Tax ID family
Walter S Green MD Medical Corporation4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231545600000",
    "number": "1114120243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "657 CAMINO DE LOS MARES STE 242",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926732811",
            "telephone_number": "949-496-6066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "657 CAMINO DE LOS MARES STE 242",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926732811",
            "telephone_number": "949-496-6066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALTER S GREEN MD MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-06",
        "last_updated": "2009-01-10",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "949-496-6066",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A09766",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Clemente, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.