Ottavia Kimberly Green, MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

036-170213 Issued in IL

Practice address

1775 Dempster St
Park Ridge, IL 60068-1143

Phone

(847) 723-2210

NPI assigned

Jul 4, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Electronic endpoints 3

Medicare fee-for-service enrollment

Enrolled in MA, TX, IL3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 3

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ogreen36542@direct.bostonchildrens.org

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.

• Advocate Health and Hospitals Corporation

  • Multi-Specialty Clinic/Center
  • Oak Brook, IL
  • NPI 1700824455
  Medicare reassignment NPD
• Mass General Brigham Medical Group Western Massachusetts Inc

  • Family Medicine Physician
  • Northampton, MA
  • NPI 1295787919
  Medicare reassignment NPD
• U. S. Anesthesia Partners of Texas, P.a.,

  • Anesthesiology Physician
  • Houston, TX
  • NPI 1548208564
  Medicare reassignment NPD
• Advocate Health and Hospitals Corporation

  • Children's Hospital
  • Oak Lawn, IL
  • NPI 1508315516
  NPD
• U S Anesthesia Partners of Texas, PA

  • Interventional Pain Medicine Physician
  • Addison, TX
  • NPI 1053800391

  Anesthesiology

  NPD

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

{
    "created_epoch": "1562198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738713600000",
    "number": "1336701861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29373 NETWORK PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606731293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1775 DEMPSTER ST",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681143",
            "telephone_number": "847-723-2210"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Barnes Jewish Hospital Plz",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631101003",
            "country_code": "US",
            "telephone_number": "314-362-1935",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREEN",
        "first_name": "OTTAVIA",
        "middle_name": "KIMBERLY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-04",
        "last_updated": "2025-02-05",
        "certification_date": "2025-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MO",
            "license": "2019022382",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "TX",
            "license": "V0407",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": "036-170213",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ottaviagreen@wustl.edu",
            "affiliation": "N",
            "endpointDescription": "email",
            "address_1": "1 Barnes Jewish Hospital Plz",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631101003",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "1775 Dempster St",
            "city": "Park Ridge",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600681143",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ogreen411414@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1775 Dempster St",
            "city": "Park Ridge",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600681143",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• David E. Grauer, D.D.S.
• Judith Ann Gravdal, M.D.
• Shelby Noel Graves, LPC, ATR
• Allison Gray, M.A. CCC-SLP/L
• Erin Caveney Green, CCC-SLP
• Bret Greenberg
• Ryan Driscoll Greene, M.D.
• Eric Jeffrey Greenglass, MD
• Heidi Goeppinger Greening, D.O.
• Bruce R Greenspahn, MD

• Anesthesiology Physician in Park Ridge, IL
• Providers in Park Ridge, IL by specialty
• Anesthesiology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.