NPIMap

Individual provider Active NPI

Shay F Green, APRN

  • Acute Care Nurse Practitioner
  • Middletown, CT
National Provider Identifier
1255520060
Registry record updated Mar 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
003655 Issued in CT
Practice address
28 Crescent St
Middletown, CT 06457-3654
Phone
(860) 358-5322
Fax
(860) 358-6298
NPI assigned
Oct 17, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 003655 CT
Acute Care Nurse Practitioner 363LA2100X 003655 CT Primary

Addresses

Primary practice location

28 Crescent St
Middletown, CT 06457-3654

Mailing address

28 Crescent St
Middletown, CT 06457-3654
Phone (860) 358-5322

Other identifiers 2

IdentifierTypeStateIssuer
3V0093OtherCTHEALTHNET
400003655CTOtherCTANTHEM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20080114000590 CT Practitioner - Nurse Practitioner 4486735685 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hospital Medicine Associates LLCGroup PAC ID 9234156985, 208 clinicians

Practice addresses (Care Compare)

365 Montauk Ave
New London, CT 06320-4700
Phone (860) 442-0711

Hospital & facility affiliations

  • Lawrence & Memorial Hospital Hospital, New London, CT, CCN 070007
  • Westerly Hospital Hospital, Westerly, RI, CCN 410013

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3655CTMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ipc Hospitalists of New England, P.C. Nurse Practitioner CurrentSince Sep 20, 2011 Accepting new patients
Trinity Health of New England Provider Network Organization Inc Nurse Practitioner CurrentSince Oct 10, 2011 Accepting new patients
Ipc Hospitalists of New England PC Nurse Practitioner CurrentSince Sep 20, 2011 Accepting new patients
Trinity Health of New England Provider Network Organization Inc CurrentSince Oct 10, 2011 Accepting new patients
Associated Specialists of Southeastern Connecticut, Inc. Acute Care Past Accepting new patients
Middlesex Hospital Past Accepting new patients
Middlesex Hospital Nurse Practitioner PastSince Sep 1, 2001 Accepting new patients

Locations

114 Woodland St
Hartford, CT 06105
Phone (860) 714-4001

365 Montauk Ave
New London, CT 06320
Phone (860) 271-4364

819 Worcester St
Ste 3
Springfield, MA 01151
Phone (413) 543-6820

25 Wells St
Westerly, RI 02891
Phone (401) 348-3325

Interoperability endpoints

  • Direct secure messaging: sgreen329685@direct.ynhh.org

Organizations & group practices 8

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.

Hospital & facility affiliations 3

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": "1192579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394496000000",
    "number": "1255520060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 CRESCENT ST",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064573654",
            "telephone_number": "860-358-5322",
            "fax_number": "860-358-6298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 CRESCENT ST",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064573654",
            "telephone_number": "860-358-5322",
            "fax_number": "860-358-6298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "SHAY",
        "middle_name": "F",
        "name_prefix": "Mr.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-17",
        "last_updated": "2014-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CT",
            "license": "003655",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CT",
            "license": "003655",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "3V0093",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "400003655CT",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Middletown, CT

Sources for this page

Verify at the official NPI Registry.