Randall L Green, PHD CLINICAL PSYCHOL

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

585 Issued in OR

Practice address

2250 D St NE
Salem, OR 97301-2768

Phone

(503) 364-6093

Fax

(503) 364-5121

NPI assigned

Nov 30, 2006

Sex

Male

Sole proprietor

Yes

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

Enrolled in OR

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mid Valley Counseling Center IncGroup PAC ID 2769479948, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

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.

• Mid Valley Counseling Center Inc

  • Clinical Psychologist
  • Salem, OR
  • NPI 1407039308
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204761600000",
    "number": "1154498269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2250 D ST NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973012768",
            "telephone_number": "503-364-6093",
            "fax_number": "503-364-5121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2250 D ST NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973012768",
            "telephone_number": "503-364-6093",
            "fax_number": "503-364-5121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "RANDALL",
        "middle_name": "L",
        "credential": "PHD CLINICAL PSYCHOL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-30",
        "last_updated": "2008-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Green Oak Mental Health LLC
• Alison J Green, MSN, FNP-C
• Angella Dinina Green, FNP
• Chelsea E Green, LPC
• Jacqueline Green
• Sidney I Green, M.D.
• Kenneth Robert Greenbaum, DDS, MS
• Lilli Greenberg
• Kate Greenwood, CSWA, QMHPC, CADCIII
• Adrienne M Greer

• Clinical Psychologist in Salem, OR
• Providers in Salem, OR by specialty
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2008; 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.