NPIMap

Individual provider Active NPI

Troy Green, PA-C

  • Physician Assistant
  • Lakeway, TX
National Provider Identifier
1205297082
Registry record updated Dec 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA10544 Issued in TX
Practice address
200 Medical Pkwy Ste 370
Lakeway, TX 78738-1798
Phone
(512) 445-5998
Fax
(512) 443-4388
NPI assigned
Mar 8, 2016
Last updated
Dec 23, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 23, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA10544 TX Primary

Addresses

Primary practice location

200 Medical Pkwy Ste 370
Lakeway, TX 78738-1798

Mailing address

PO Box 844658
Dallas, TX 75284-4658

Other practice location 1

213 Heart Dr
Brownsville, TX 78520-3602
Phone (956) 504-3278

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tgreen437795@direct.sw.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161114002174 TX Practitioner - Physician Assistant 2264711316 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Blue Agave Functional Medicine Clinic PLLCGroup PAC ID 6800333568, 6 clinicians

Practice addresses (Care Compare)

651 S Business Ih
35 Suite 730
New Braunfels, TX 78130-4794
Phone (830) 491-4040

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Agave Functional Medicine Bulverde PLLC CurrentSince Jul 1, 2026 Accepting new patients
Scott & White Clinic CurrentSince Dec 13, 2018 Accepting new patients

Locations

101 Lafferty Ave
Cameron, TX 76520
Phone (254) 605-1100

200 Medical Pkwy
Ste 370
Lakeway, TX 78738
Phone (512) 445-5998

1701 E Pflugerville Pkwy
Pflugerville, TX 78660
Phone (512) 259-6000

302 University Blvd
Round Rock, TX 78665
Phone (512) 218-6330

20475 Highway 46 W
Ste 350
Spring Branch, TX 78070
Phone (512) 293-9800

2401 S 31st St
Temple, TX 76508
Phone (254) 724-2459

Interoperability endpoints

  • Direct secure messaging: tgreen437795@direct.sw.org

Organizations & group practices 5

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

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1457395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640217600000",
    "number": "1205297082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MEDICAL PKWY STE 370",
            "city": "LAKEWAY",
            "state": "TX",
            "postal_code": "787381798",
            "telephone_number": "512-445-5998",
            "fax_number": "512-443-4388"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "213 Heart Dr",
            "address_purpose": "LOCATION",
            "city": "Brownsville",
            "state": "TX",
            "postal_code": "785203602",
            "country_code": "US",
            "telephone_number": "956-504-3278",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREEN",
        "first_name": "TROY",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-03-08",
        "last_updated": "2021-12-23",
        "certification_date": "2021-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA10544",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tgreen437795@direct.sw.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "200 Medical Pkwy Ste 370",
            "city": "Lakeway",
            "state": "TX",
            "country_code": "US",
            "postal_code": "787381798",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lakeway, TX

Sources for this page

Verify at the official NPI Registry.