Roger Leroy Green, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

R4063 Issued in AR

Practice address

1200 McLain St
Newport, AR 72112-3534

Phone

(870) 523-9852

Fax

(870) 523-3583

NPI assigned

Jun 10, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• National Healthcare of Newport Inc

  dba Harris Hospital ER

  • Emergency Medicine Physician
  • Newport, AR
  • NPI 1073720330
  NPD (past)
• National Healthcare of Newport Inc

  dba Harris Anesthesia Associates

  • Anesthesiology Physician
  • Newport, AR
  • NPI 1255548517
  NPD (past)

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

{
    "created_epoch": "1118361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330041600000",
    "number": "1275537912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 MCLAIN ST",
            "city": "NEWPORT",
            "state": "AR",
            "postal_code": "721123534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 MCLAIN ST",
            "city": "NEWPORT",
            "state": "AR",
            "postal_code": "721123534",
            "telephone_number": "870-523-9852",
            "fax_number": "870-523-3583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "ROGER",
        "middle_name": "LEROY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-10",
        "last_updated": "2012-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "R4063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "52008",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102811001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephen J. Graham Jr.
• Ahmad Granberry, CMP
• Green Valley Healthcare, LLC
• Alison Louise Green, MD
• Andrew Green, MHPP
• Starla J Green
• Kathleen Grendell, RECOVERY ASSISTANT
• Tracy Caroline Guadamuz, PT
• Guilford M. Dudley, M.D., P.a.
• Stephanie Hagar

• Family Medicine Physician in Newport, AR
• Providers in Newport, AR by specialty
• Family Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.