Thomas Alan Green, FNP-BC
Individual provider Active NPI Family Nurse Practitioner · Sun City, AZ
NPI 1477511665 · NPPES record last updated Feb 8, 2022
Key facts
- NPI
- 1477511665
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- RN078764 (AZ)
- Practice address
- 12630 N 103Rd Ave Ste 142
Sun City, AZ 85351-3463 - Phone
- (480) 275-2022
- Fax
- (888) 551-6092
- NPI assigned
- May 4, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 4
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2002
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Az at Home Inc
Practice addresses (Care Compare)
12630 N 103Rd Ave
Suite 142
Sun City, AZ 85351-3463
Phone (480) 275-2022
Hospital & facility affiliations
- Advisacare Solutions of Arizona, LLC
- Americare Hospice and Palliative Care
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20031104000625 | AZ | Practitioner - Nurse Practitioner | 3274445556 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN078764 | AZ | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Az at Home Inc | Family | Current |
Accepting new patients |
| Asap Health Solutions Inc | Past | Accepting new patients | |
| Team Physicians of Arizona PC | Past | Accepting new patients | |
| Home Health Resources, LLC | Past | Accepting new patients |
Locations
12630 N 103rd Ave
Ste 142
Sun City, AZ 85351
Phone (480) 275-2022
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | RN078764 | AZ | Yes |
Addresses
Primary practice location
12630 N 103Rd Ave Ste 142
Sun City, AZ 85351-3463
Mailing address
12630 N 103Rd Ave Ste 142
Sun City, AZ 85351-3463
Phone (480) 275-2022
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 769044 | Medicaid | AZ |
Other providers in Sun City, AZ
- Kristine Gradisher
- Meredith Grady
- Grand Dental Care, PC
- Grand West Family Practice and Wellness LLC
- Heidi Lee Grande
- Gregory Alan Greenbaum
- David Lawrence Greene
- Lisa Teresa Greene
- Lindsey Greenup
- Annet Grijalva
All providers in Sun City, AZ · Family Nurse Practitioner in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 8, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.