Active NPI
Jonathan Michael Green, CNIM
- Electroneurodiagnostic Specialist/Technologist
- Colorado Springs, CO
National Provider Identifier
1467829192
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Electroneurodiagnostic Specialist/Technologist
- License
- 2612
- Practice address
- 13 S Tejon St FL 5
Colorado Springs, CO 80903-1513 - Phone
- (866) 286-8576
- NPI assigned
- Aug 28, 2015
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Electroneurodiagnostic Specialist/Technologist | 246ZE0600X | 2612 | MD | Primary |
Addresses
Primary practice location
13 S Tejon St FL 5
Colorado Springs, CO 80903-1513
Mailing address
8540 SW Ash Meadows Rd
113
Wilsonville, OR 97070-4014
Phone (301) 335-4422
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2612 | MD | MD | Electroneurodiagnostic Specialist/Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1440720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1440720000000",
"number": "1467829192",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8540 SW ASH MEADOWS RD",
"address_2": "113",
"city": "WILSONVILLE",
"state": "OR",
"postal_code": "970704014",
"telephone_number": "301-335-4422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13 S TEJON ST FL 5",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809031513",
"telephone_number": "866-286-8576"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "JONATHAN",
"middle_name": "MICHAEL",
"credential": "CNIM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-08-28",
"last_updated": "2015-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "246ZE0600X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Electroneurodiagnostic",
"state": "MD",
"license": "2612",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.