Roger Elliott Green, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

C36384 Issued in CA

Practice address

657 Camino de Los Mares
Suite 242
San Clemente, CA 92673

Phone

(949) 496-6066

Fax

(949) 496-6497

NPI assigned

Jan 19, 2006

Last updated

Nov 18, 2009By the provider in NPPES

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 CA

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 1

Specialty

Dermatology

Education

University of Louisville School of Medicine, 1973

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

97.36 of 100Reported as individual

Quality

94.72

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: regreen@greendermsc.emadirect.md

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.

• Green Dermatologic Medical Group a Medical Corporation

  • Specialist
  • San Clemente, CA
  • NPI 1154533685
  NPD Authorized official
• Walter S Green MD Medical Corporation

  • Specialist
  • San Clemente, CA
  • NPI 1114120243
  NPD (past)

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

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258502400000",
    "number": "1215917968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "657 CAMINO DE LOS MARES",
            "address_2": "SUITE 242",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926732826",
            "telephone_number": "949-496-6066",
            "fax_number": "949-496-6497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "657 CAMINO DE LOS MARES",
            "address_2": "SUITE 242",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "92673",
            "telephone_number": "949-496-6066",
            "fax_number": "949-496-6497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "ROGER",
        "middle_name": "ELLIOTT",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-19",
        "last_updated": "2009-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "C36384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maritza Granados, ACSW, PPSC
• Gratias, Inc.
• Greathouse Chiropractic Inc
• Wayne Greathouse, DC
• Green Dermatologic Medical Group a Medical Corporation
• Matthew Alan Greene
• Suzanne Greene
• Nicola Greenhalgh
• Tahjaniera A Greenwade, LVN
• Gregory Clibon, DDS - Beach Cities Dental Group, Apc

• Dermatology Physician in San Clemente, CA
• Providers in San Clemente, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2009; 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.