Active NPI
Charles Jacob Green III
- Case Manager/Care Coordinator
- Toledo, OH
National Provider Identifier
1285110460
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 2005 Ashland Ave
Toledo, OH 43620-1703 - Phone
- (419) 841-7701
- NPI assigned
- Jul 11, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Social Worker | 104100000X | S.2403902-TRNE | OH | |
| Case Manager/Care Coordinator | 171M00000X | Primary |
Addresses
Primary practice location
2005 Ashland Ave
Toledo, OH 43620-1703
Mailing address
2005 Ashland Ave
Toledo, OH 43620-1703
Phone (419) 841-7701
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S.2403902-TRNE | OH | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Zepf Center | Addiction (Substance Use Disorder) | Past | Accepting new patients |
| Zepf Center | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Community/Behavioral Health Agency
- Toledo, OH
- NPI 1215947809
-
- Community/Behavioral Health Agency
- Toledo, OH
- NPI 1942566468
Addiction (Substance Use Disorder)
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1531267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727049600000",
"number": "1285110460",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2005 ASHLAND AVE",
"city": "TOLEDO",
"state": "OH",
"postal_code": "436201703",
"telephone_number": "419-841-7701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2005 ASHLAND AVE",
"city": "TOLEDO",
"state": "OH",
"postal_code": "436201703",
"telephone_number": "419-841-7701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "CHARLES",
"middle_name": "JACOB",
"name_suffix": "III",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-07-11",
"last_updated": "2024-09-23",
"certification_date": "2024-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OH",
"license": "S.2403902-TRNE",
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Toledo, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.