Active NPI
Charles Bruce Green, M.D.
- Family Medicine Physician
- Washington, DC
National Provider Identifier
1336262559
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- G48009
- Practice address
- HQ Usaf SG
1780 Air Force Pentagon
Washington, DC 20330-0001 - Phone
- (202) 767-4766
- Fax
- (202) 404-7084
- NPI assigned
- Apr 10, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | G48009 | CA | Primary |
Addresses
Primary practice location
HQ Usaf SG
1780 Air Force Pentagon
Washington, DC 20330-0001
Mailing address
84 Westover Ave SW
Bolling AFB, DC 20032-7432
Phone (210) 862-7592
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G48009 | CA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1336262559",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "84 WESTOVER AVE SW",
"city": "BOLLING AFB",
"state": "DC",
"postal_code": "200327432",
"telephone_number": "210-862-7592",
"fax_number": "202-404-7084"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "HQ USAF SG",
"address_2": "1780 AIR FORCE PENTAGON",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "203300001",
"telephone_number": "202-767-4766",
"fax_number": "202-404-7084"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "CHARLES",
"middle_name": "BRUCE",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "G48009",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.