James Russell Green IV, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

18270 Issued in FL

Practice address

1309 W Fletcher Ave
Tampa, FL 33612

Phone

(813) 960-5540

NPI assigned

May 15, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Feb 11, 2025 through Feb 11, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1242345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522108800000",
    "number": "1396970653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1309 W FLETCHER AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "33612",
            "telephone_number": "813-960-5540",
            "fax_number": "813-961-1599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1309 W FLETCHER AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "33612",
            "telephone_number": "813-960-5540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "JAMES",
        "middle_name": "RUSSELL",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-15",
        "last_updated": "2018-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "P64379",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": "P64379",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "18270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eric R Green, DMD
• Ethan Edwin Green, MD
• Frank Clifford Green III, MD
• Geannette Green, PHARMD
• Gwendolyn Green
• Jamie Lee Green, M.S.ED., MSW
• Jardena Marie Green
• Jennifer Ann Green, OTR/L
• Jennifer Laura Green, PHARMD, RPH
• Kenneth H Green, OD

• Oral and Maxillofacial Surgery (Dentist) in Tampa, FL
• Providers in Tampa, FL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2018; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.