NPIMap

Individual provider Active NPI

Kevin B Green, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • New London, CT
National Provider Identifier
1356307334
Registry record updated Oct 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
049143 Issued in CT
Practice address
365 Montauk Ave
New London, CT 06320-4700
Phone
(860) 444-5100
Fax
(860) 444-3709
NPI assigned
Apr 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 049143 CT Primary

Addresses

Primary practice location

365 Montauk Ave
New London, CT 06320-4700

Mailing address

PO Box 902
New Haven, CT 06504-0902
Phone (203) 397-8000

Other identifiers 1

IdentifierTypeStateIssuer
008022648MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, RI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20101019001399 CT Practitioner - Pathology 4183640717 Reassigns benefits to 1 organization
I20130813000936 RI Practitioner - Pathology 4183640717 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
University of Texas Medical School at San Antonio, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pathology Consultants of New London PCGroup PAC ID 0840369740, 5 clinicians

Practice addresses (Care Compare)

25 Wells St
Westerly, RI 02891-2922
Phone (401) 348-3320

25 Wells St
Westerly, RI 02891-2934

365 Montauk Ave
New London, CT 06320-4700
Phone (860) 444-5100

Hospital & facility affiliations

  • Lawrence & Memorial Hospital Hospital, New London, CT, CCN 070007
  • Westerly Hospital Hospital, Westerly, RI, CCN 410013
  • William W Backus Hospital Hospital, Norwich, CT, CCN 070024
  • Yale-New Haven Hospital Hospital, New Haven, CT, CCN 070022

Merit-based Incentive Payment System (MIPS)

Final score
94.63 of 100Reported as group
Quality
89.25
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
049143CTMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
LMW Healthcare Inc. Past Accepting new patients
Lawrence and Memorial Hospital, Inc. Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: kgreen329722@direct.ynhh.org

Organizations & group practices 3

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.

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": "1414108800000",
    "number": "1356307334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 902",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065040902",
            "telephone_number": "203-397-8000",
            "fax_number": "203-389-1540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "365 MONTAUK AVE",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063204700",
            "telephone_number": "860-444-5100",
            "fax_number": "860-444-3709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "KEVIN",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-26",
        "last_updated": "2014-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CT",
            "license": "049143",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008022648",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New London, CT

Sources for this page

Verify at the official NPI Registry.