Active NPI
Jon Norman Green, M.D.
- Family Medicine Physician
- Woodland Park, CO
National Provider Identifier
1306020292
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 33056
- Practice address
- 145 Radiant CT
Woodland Park, CO 80863-9073 - Phone
- (719) 687-0850
- Fax
- (508) 300-5891
- NPI assigned
- Dec 27, 2007
- Last updated
- Dec 27, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 33056 | CO | |
| Family Medicine Physician | 207Q00000X | 33056 | CO | Primary |
Addresses
Primary practice location
145 Radiant CT
Woodland Park, CO 80863-9073
Mailing address
145 Radiant CT
Woodland Park, CO 80863-9073
Phone (719) 687-0850
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33056 | CO | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198713600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1198713600000",
"number": "1306020292",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "145 RADIANT CT",
"city": "WOODLAND PARK",
"state": "CO",
"postal_code": "808639073",
"telephone_number": "719-687-0850",
"fax_number": "508-300-5891"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "145 RADIANT CT",
"city": "WOODLAND PARK",
"state": "CO",
"postal_code": "808639073",
"telephone_number": "719-687-0850",
"fax_number": "508-300-5891"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "JON",
"middle_name": "NORMAN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-12-27",
"last_updated": "2007-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "CO",
"license": "33056",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CO",
"license": "33056",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodland Park, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.