Active NPI
Jennifer D Green, CST
- Surgical Physician Assistant
- Baytown, TX
National Provider Identifier
1124156922
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 102511
- Practice address
- 2635 Baker Rd.
Baytown, TX 77521 - Phone
- (281) 837-8550
- Fax
- (281) 837-8709
- NPI assigned
- Mar 1, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 102511 | TX | Primary |
Addresses
Primary practice location
2635 Baker Rd.
Baytown, TX 77521
Mailing address
7401 S. Main
Houston, TX 77030
Phone (713) 799-2300
Other names 1
- Jennifer D Moore
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 102511 | TX | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1336694400000",
"number": "1124156922",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7401 S. MAIN",
"city": "HOUSTON",
"state": "TX",
"postal_code": "77030",
"telephone_number": "713-799-2300",
"fax_number": "713-794-3395"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2635 BAKER RD.",
"city": "BAYTOWN",
"state": "TX",
"postal_code": "77521",
"telephone_number": "281-837-8550",
"fax_number": "281-837-8709"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "JENNIFER",
"middle_name": "D",
"credential": "CST",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-01",
"last_updated": "2012-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "TX",
"license": "102511",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JENNIFER",
"last_name": "MOORE",
"middle_name": "D",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Baytown, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.