NPIMap

Individual provider Active NPI

Bryan Robert Green, MD

  • Family Medicine Physician
  • Maryville, MO
National Provider Identifier
1295791366
Registry record updated Oct 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2005034471 Issued in MO
Practice address
2016 S Main St
Maryville, MO 64468-2655
Phone
(660) 562-7999
Fax
(660) 562-7996
NPI assigned
Apr 26, 2006
Last updated
Oct 9, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2005034471 MO Primary

Addresses

Primary practice location

2016 S Main St
Maryville, MO 64468-2655

Mailing address

2016 S Main St
Maryville, MO 64468-2655
Phone (660) 562-2525

Other practice location 1

3817 S Springfield Ave Ste 140
Bolivar, MO 65613-9129
Phone (417) 422-4769

Other identifiers 6

IdentifierTypeStateIssuer
1295791366MedicaidMO
1295791366OtherMOTRICARE
49561031OtherMOBCBSKC
P00273140OtherMORR MEDICARE
1295791366MedicaidIA
201084370AMedicaidKS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20051221000027 MO Practitioner - Family Practice 2466474333 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Missouri, Columbia School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SSM Regional Health ServicesGroup PAC ID 8921917352, shared by 13 NPIs, 165 clinicians

Practice addresses (Care Compare)

2016 S Main St
Maryville, MO 64468-2655
Phone (660) 562-2525

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Springfield Communities Family Medicine CurrentSince Apr 25, 2022 Accepting new patients
Mosaic Medical Center - Maryville Family Medicine CurrentSince Jan 6, 2023 Accepting new patients
Mosaic Medical Center - Maryville CurrentSince Jan 6, 2023 Accepting new patients
Mercy St. Francis Hospital PastSince Jul 1, 2009 Accepting new patients
Mosaic Medical Center - Maryville Past Accepting new patients
Mosaic Medical Center - Maryville Past Accepting new patients
Ozarks Medical Center Family Medicine Past Accepting new patients

Locations

3817 S Springfield Ave
Bolivar, MO 65613
Phone (417) 422-4769

3817 S Springfield Ave
Ste 140
Bolivar, MO 65613
Phone (417) 422-4769

114 E South Hills Dr
Maryville, MO 64468
Phone (660) 562-2525

2016 S Main St
Maryville, MO 64468
Phone (660) 562-2525

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

1605 Martin Springs Dr
Ste 330
Rolla, MO 65401
Phone (573) 458-6379

301 E Price Ave
Ste A
Savannah, MO 64485
Phone (816) 324-5644

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728432000000",
    "number": "1295791366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2016 S MAIN ST",
            "city": "MARYVILLE",
            "state": "MO",
            "postal_code": "644682655",
            "telephone_number": "660-562-2525",
            "fax_number": "660-562-7996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2016 S MAIN ST",
            "city": "MARYVILLE",
            "state": "MO",
            "postal_code": "644682655",
            "telephone_number": "660-562-7999",
            "fax_number": "660-562-7996"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3817 S Springfield Ave Ste 140",
            "address_purpose": "LOCATION",
            "city": "Bolivar",
            "state": "MO",
            "postal_code": "656139129",
            "country_code": "US",
            "telephone_number": "417-422-4769",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREEN",
        "first_name": "BRYAN",
        "middle_name": "ROBERT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-26",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2005034471",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295791366",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "1295791366",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSKC",
            "identifier": "49561031",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00273140",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295791366",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201084370A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maryville, MO

Sources for this page

Verify at the official NPI Registry.