NPIMap

Individual provider Active NPI

Clyde O. Green, MD

  • Family Medicine Physician
  • Macon, GA
National Provider Identifier
1417178187
Registry record updated Jan 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
30072 Issued in GA
Practice address
841 Mulberry St
Macon, GA 31201-6756
Phone
(478) 741-6554
Fax
(478) 743-7052
NPI assigned
May 1, 2007
Last updated
Jan 21, 2015By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 21, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 30072 GA Primary
Hospice and Palliative Medicine (Family Medicine) Physician 207QH0002X 30072 GA

Addresses

Primary practice location

841 Mulberry St
Macon, GA 31201-6756

Mailing address

841 Mulberry St
Macon, GA 31201-6756
Phone (478) 741-6554

Other identifiers 9

IdentifierTypeStateIssuer
105116OtherGAPEACH STATE
1451889OtherGAUNITED HEALTH CARE
157763300OtherGAWORKER COMP
D45482GRE00OtherGASECURE CHOICE HEALTH
324341OtherGAWELLCARE
508457OtherGABLUE CROSS BLUE SHIELD
00358432 D, E, F, JMedicaidGA
157763302OtherGAWORKERS COMP
157763301OtherGAWORKERS COMP

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070806000391 GA Practitioner - Family Practice 2668418054 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Howard University College of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Omni Health Solutions LLCGroup PAC ID 1658317383, 2 clinicians

Practice addresses (Care Compare)

841 Mulberry St
Macon, GA 31201-6756
Phone (478) 741-6554

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
29.31 of 100Reported as individual
Quality
15
Improvement activities
0
Cost
44.38

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
030072GAMDPharmacist
30072GAMDHospice and Palliative Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Compassus Op of Georgia II LLC Hospice and Palliative Medicine CurrentSince Aug 1, 2019 Accepting new patients
Omni Health Solutions LLC Family Medicine CurrentSince Jan 1, 1996 Accepting new patients
Medical Management Health & Rehab Center LLC Past Accepting new patients
Atlantic Hospitalist Group Inc Past Accepting new patients
Coliseum Drive Associates LLC Past Accepting new patients

Locations

1100 Northside Xing
Macon, GA 31210
Phone (478) 321-9071

841 Mulberry St
Macon, GA 31201
Phone (478) 741-1192

10 Cadillac Dr
Ste 400
Brentwood, TN 37027
Phone (615) 637-9163

Interoperability endpoints

  • Direct secure messaging: cgreen@96.securemail.prognocis.com

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Medical Management Health and Rehab CenterMacon, GA, CCN 115692 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 28, 2025
Jan 28, 2025
Compassus Hospice and Palliative Care- MaconMacon, GA, CCN 111671 Hospice Contracted Managing Employee Sep 1, 2017

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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.

Hospital & facility affiliations 6

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": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421798400000",
    "number": "1417178187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "841 MULBERRY ST",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312016756",
            "telephone_number": "478-741-6554",
            "fax_number": "478-743-7052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "841 MULBERRY ST",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312016756",
            "telephone_number": "478-741-6554",
            "fax_number": "478-743-7052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "CLYDE",
        "middle_name": "O.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-01",
        "last_updated": "2015-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "30072",
            "primary": true
        },
        {
            "code": "207QH0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": "GA",
            "license": "30072",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEACH STATE",
            "identifier": "105116",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "1451889",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKER COMP",
            "identifier": "157763300",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SECURE CHOICE HEALTH",
            "identifier": "D45482GRE00",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "324341",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "508457",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00358432 D, E, F, J",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKERS COMP",
            "identifier": "157763302",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKERS COMP",
            "identifier": "157763301",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

Verify at the official NPI Registry.