Jason Green, DO

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

OS8871 Issued in FL

Practice address

5721 NE 27TH Ave
Fort Lauderdale, FL 33308-2703

Phone

(954) 772-0416

Fax

(954) 772-5716

NPI assigned

Aug 29, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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 1

Specialty

Dermatology

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vitalmd Group Holding LLCGroup PAC ID 8921091786, 535 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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 and National Provider Directory roles.

• Jason Green DO PA

  dba Green Dermatology & Cosmetic Center

  • Medical Specialty Clinic/Center
  • Deerfield Beach, FL
  • NPI 1649726316
  Medicare reassignment NPD Authorized official
• Vitalmd Group Holding LLC

  • Obstetrics & Gynecology Physician
  • Miami, FL
  • NPI 1871572032

  Dermatology

  Medicare reassignment Care Compare group NPD
• Dermatology and Cosmetic Center, P.a.

  dba Eastside Dermatology, P.a.

  • MOHS-Micrographic Surgery Physician
  • Fort Lauderdale, FL
  • NPI 1932304888
  NPD
• Eastside Dermatology, PA

  • Clinical Medical Laboratory
  • Fort Lauderdale, FL
  • NPI 1477853125
  NPD

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1427167261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 LAKE LUCIEN DR STE 180",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517235",
            "telephone_number": "407-875-2080",
            "fax_number": "407-875-0518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5721 NE 27TH AVE",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333082703",
            "telephone_number": "954-772-0416",
            "fax_number": "954-772-5716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "JASON",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "OS8871",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Greater Ft Lauderdale Heart Group
• Anthony Green
• Debra Lynn Green, ARNP
• Dory Green, DMD, FAGD
• Fiona Yvonne Green, LMT
• Kerry Lynn Green
• Railton Green, M.D.
• Shelley K Green, PH.D., LMFT
• Sherae Monique Green
• Wynette Benson Green, LMFT

• Dermatology Physician in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.