Active NPI
Brooklyn Walsh Green, PA-C
- Physician Assistant
- Thomasville, GA
National Provider Identifier
1447837828
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 12179
- Practice address
- 100 Mimosa Dr FL 2
Thomasville, GA 31792-6676 - Phone
- (229) 228-5500
- Fax
- (229) 584-5985
- NPI assigned
- Mar 24, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9114960 | FL | |
| Physician Assistant | 363A00000X | 12179 | GA | Primary |
Addresses
Primary practice location
100 Mimosa Dr FL 2
Thomasville, GA 31792-6676
Mailing address
100 Mimosa Dr FL 2
Thomasville, GA 31792-6676
Phone (229) 228-5500
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA9114960 | Other | FL | FLORIDA MEDICAL LICENSE NO. |
| 12179 | Other | GA | GEORGIA MEDICAL LICENSE NO. |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
100 Mimosa Dr
Thomasville, GA 31792-6676
Phone (229) 228-5500
915 Gordon Ave
Thomasville, GA 31792-6614
Phone (229) 228-2000
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA9114960 | FL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hospital Authority of the City of Bainbridge and Decatur County | Past | Accepting new patients | |
| Archbold Medical Group, Inc. | Past | Accepting new patients |
Interoperability endpoints
- bgreen109139@direct.nemours.org
Organizations & group practices 2
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.
-
- Surgery Physician
- Thomasville, GA
- NPI 1831353036
-
- Multi-Specialty Clinic/Center
- Bainbridge, GA
- NPI 1053388256
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Cairo, GA
- NPI 1013961507
-
- Critical Access Hospital
- Camilla, GA
- NPI 1700830247
-
- Multi-Specialty Clinic/Center
- Bainbridge, GA
- NPI 1053388256
Hospital
-
- General Acute Care Hospital
- Thomasville, GA
- NPI 1194779702
-
- Rehabilitation Hospital Unit
- Thomasville, GA
- NPI 1104867738
-
- General Acute Care Hospital
- Valdosta, GA
- NPI 1144096553
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616544000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713571200000",
"number": "1447837828",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 MIMOSA DR FL 2",
"city": "THOMASVILLE",
"state": "GA",
"postal_code": "317926676",
"telephone_number": "229-228-5500",
"fax_number": "229-584-5985"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 MIMOSA DR FL 2",
"city": "THOMASVILLE",
"state": "GA",
"postal_code": "317926676",
"telephone_number": "229-228-5500",
"fax_number": "229-584-5985"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "BROOKLYN",
"middle_name": "WALSH",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-03-24",
"last_updated": "2024-04-20",
"certification_date": "2024-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9114960",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "GA",
"license": "12179",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FLORIDA MEDICAL LICENSE NO.",
"identifier": "PA9114960",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GEORGIA MEDICAL LICENSE NO.",
"identifier": "12179",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Thomasville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 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.
- 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.