Jacob Alan Greene, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4671 Issued in WV

Practice address

111 S Grove St Ste 1
Petersburg, WV 26847-1805

Phone

(304) 257-2451

NPI assigned

Sep 2, 2020

Last updated

May 22, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WV

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• E.a. Hawse Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Baker, WV
  • NPI 1851359251
  Medicare reassignment NPD
• E. a. Hawse Health Center, Inc.

  • Community Health Clinic/Center
  • Moorefield, WV
  • NPI 1417437591
  NPD

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

{
    "created_epoch": "1599004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716336000000",
    "number": "1407460942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 97",
            "city": "BAKER",
            "state": "WV",
            "postal_code": "268010097",
            "telephone_number": "304-897-5915",
            "fax_number": "304-897-8472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S GROVE ST STE 1",
            "city": "PETERSBURG",
            "state": "WV",
            "postal_code": "268471805",
            "telephone_number": "304-257-2451"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6214 Bradley Park Dr",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "GA",
            "postal_code": "319043078",
            "country_code": "US",
            "telephone_number": "706-322-8988",
            "fax_number": "706-327-2907",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "614 W Main St",
            "address_purpose": "LOCATION",
            "city": "Manchester",
            "state": "GA",
            "postal_code": "318161542",
            "country_code": "US",
            "telephone_number": "706-441-0405",
            "fax_number": "706-441-0474",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREENE",
        "first_name": "JACOB",
        "middle_name": "ALAN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-02",
        "last_updated": "2024-05-22",
        "certification_date": "2024-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN016106",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WV",
            "license": "4671",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Petersburg, WV
• Providers in Petersburg, WV by specialty
• General Practice Dentistry in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2024; 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.