Janiel J Green, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA-957 Issued in ID

Practice address

36 Professional PLZ
Suite #102
Rexburg, ID 83440-2049

Phone

(208) 356-0234

Fax

(208) 656-8444

NPI assigned

Dec 30, 2011

Last updated

Dec 30, 2011By the provider in NPPES

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Physician Assistant

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

{
    "created_epoch": "1325203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325203200000",
    "number": "1114297660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36 PROFESSIONAL PLZ",
            "address_2": "SUITE #102",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834402049",
            "telephone_number": "208-356-0234",
            "fax_number": "208-656-8444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36 PROFESSIONAL PLZ",
            "address_2": "SUITE #102",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834402049",
            "telephone_number": "208-356-0234",
            "fax_number": "208-656-8444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "JANIEL",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-30",
        "last_updated": "2011-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "PA-957",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medical Physician Assistant in Rexburg, ID
• Providers in Rexburg, ID by specialty
• Medical Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 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.

Verify at the official NPI Registry.