Active NPI
Douglas Allan Greene, PA-C
- Physician Assistant
- Bountiful, UT
National Provider Identifier
1467528588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 353133-1206
- Practice address
- 214 W 1500 S
Bountiful, UT 84010-7408 - Phone
- (801) 295-6483
- NPI assigned
- Nov 28, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 353133-1206 | UT | Primary |
Addresses
Primary practice location
214 W 1500 S
Bountiful, UT 84010-7408
Mailing address
PO Box 307
Bountiful, UT 84011-0307
Phone (801) 294-6907
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 353133-1206 | UT | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Joshua M Hickman M D P C | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Specialist
- Bountiful, UT
- NPI 1932364023
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1264032000000",
"number": "1467528588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 307",
"city": "BOUNTIFUL",
"state": "UT",
"postal_code": "840110307",
"telephone_number": "801-294-6907",
"fax_number": "801-294-6917"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "214 W 1500 S",
"city": "BOUNTIFUL",
"state": "UT",
"postal_code": "840107408",
"telephone_number": "801-295-6483"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREENE",
"first_name": "DOUGLAS",
"middle_name": "ALLAN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-28",
"last_updated": "2010-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "UT",
"license": "353133-1206",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bountiful, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.