Mary Etosha Green, MD

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

74633 Issued in CT

Practice address

71 Haynes St
Manchester, CT 06040-4131

Phone

(860) 646-1222

Fax

(866) 623-8110

NPI assigned

Apr 5, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MA, CT2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Pathology

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eastern Connecticut Pathology Consultants, PCGroup PAC ID 3173511581, 19 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Manchester Memorial Hospital Hospital, Manchester, CT, CCN 070027
• Umass Memorial Health - Harrington Hospital Hospital, Southbridge, MA, CCN 220019
• Waterbury Hospital Hospital, Waterbury, CT, CCN 070005
• Holyoke Medical Center Hospital, Holyoke, MA, CCN 220024
• Samaritan Medical Center Hospital, Watertown, NY, CCN 330157

Merit-based Incentive Payment System (MIPS)

Final score

55.67 of 100Reported as group

Quality

46.42

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Eastern Connecticut Pathology Consultants, PC

  • Anatomic Pathology & Clinical Pathology Physician
  • Manchester, CT
  • NPI 1558326991

  MA

  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Manchester Memorial Hospital, Inc.

  • General Acute Care Hospital
  • Manchester, CT
  • NPI 1881564664
  Care Compare affiliation
• Prospect Waterbury, Inc.

  • General Acute Care Hospital
  • Waterbury, CT
  • NPI 1477902641
  Care Compare affiliation
• Holyoke Medical Center, Inc.

  • General Acute Care Hospital
  • Holyoke, MA
  • NPI 1750395737
  Care Compare affiliation
• Samaritan Medical Center

  • General Acute Care Hospital
  • Watertown, NY
  • NPI 1598713745
  Care Compare affiliation
• Umass Memorial Health-Harrington Hospital Inc

  • General Acute Care Hospital
  • Southbridge, MA
  • NPI 1790780047
  Care Compare affiliation

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

{
    "created_epoch": "1522886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691971200000",
    "number": "1154827350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844770",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022844770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "71 HAYNES ST",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060404131",
            "telephone_number": "860-646-1222",
            "fax_number": "866-623-8110"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "31 Union St",
            "address_purpose": "LOCATION",
            "city": "Vernon",
            "state": "CT",
            "postal_code": "060663126",
            "country_code": "US",
            "telephone_number": "860-646-1222",
            "fax_number": "866-623-8110",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "One Medical Center Blvd Winston Salem",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271570001",
            "country_code": "US",
            "telephone_number": "337-716-9954",
            "fax_number": "337-716-7595",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "64 Robbins St",
            "address_purpose": "LOCATION",
            "city": "Waterbury",
            "state": "CT",
            "postal_code": "067082613",
            "country_code": "US",
            "telephone_number": "860-646-1222",
            "fax_number": "866-623-8110",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREEN",
        "first_name": "MARY",
        "middle_name": "ETOSHA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-05",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CT",
            "license": "74633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Lee Gratton
• Catherine Gray
• Sandra C Gray, LMSW
• Bianca Graziano, MD
• Nicole D Greco, PA
• Jennifer Greer, LCSW
• Natasha Gregory
• Grier and Company, LLC
• Liam Thomas Griffin, LMFT-A
• John James Griffith, MD

• Anatomic Pathology & Clinical Pathology Physician in Manchester, CT
• Providers in Manchester, CT by specialty
• Anatomic Pathology & Clinical Pathology Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; 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.