Shellie A Green

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

F346037-1 Issued in NY

Practice address

160 Stone St
Watertown, NY 13601-3250

Phone

(585) 371-8373

Fax

(315) 222-7435

NPI assigned

Jul 16, 2020

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

Other names 1

• Shellie A Countryman Former name

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

State University of Ny Upstate Medical University, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Planned Parenthood of the North Country New York, Inc.Group PAC ID 3476531898, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: shellieanne.green.p2@direct.usppny.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Planned Parenthood of the North Country New York, Inc.

  • Ambulatory Family Planning Facility
  • Watertown, NY
  • NPI 1407907215
  Medicare reassignment Care Compare group
• Samaritan Medical Center

  • General Acute Care Hospital
  • Watertown, NY
  • NPI 1598713745
  Medicare reassignment
• Planned Parenthood of Central and Western New York, Inc

  • Ambulatory Family Planning Facility
  • Rochester, NY
  • NPI 1306909957
  NPD

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

{
    "created_epoch": "1594857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594944000000",
    "number": "1124636113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2697 MAIN ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142141701",
            "telephone_number": "585-371-8373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 STONE ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136013250",
            "telephone_number": "585-371-8373",
            "fax_number": "315-222-7435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "SHELLIE",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-16",
        "last_updated": "2020-07-17",
        "certification_date": "2020-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F346037-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELLIE",
            "last_name": "COUNTRYMAN",
            "middle_name": "A",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Daniel Stanley Gray, MD
• Great Beginnings Pediatric Dentistry PLLC
• Charrie Lynn Green
• Jessica Green
• Nicole Green, RN
• Shannon Pauline Gregory, MS, CCC-SLP
• Olivia Grenier
• Tracey Grey, RN, CNOR,CRNFA
• Alexandra Grieco, PHARM. D.
• Deborah Ann Grimes, RPH

• Family Nurse Practitioner in Watertown, NY
• Providers in Watertown, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.