Active NPI
Michael D Green, M.D.
- Pediatrics Physician
- Rochester, NY
National Provider Identifier
1487700506
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 176492
- Practice address
- 497 Beahan Rd
Rochester, NY 14624-3403 - Phone
- (585) 247-5400
- Fax
- (585) 319-4124
- NPI assigned
- Jan 25, 2007
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 176492 | NY | Primary |
Addresses
Primary practice location
497 Beahan Rd
Rochester, NY 14624-3403
Mailing address
497 Beahan Rd
Rochester, NY 14624-3403
Phone (585) 247-5400
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101264DL | Other | NY | PREFERRED CARE |
| AETNA | Other | NY | 4562184 |
| 01172072 | Medicaid | NY | |
| 6550 | Other | NY | BLUE CROSS & BLUE SHIELD |
| 010176492 | Other | NY | BLUE CHOICE |
| 000922968001 | Other | NY | HEALTH NOW |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 176492 | NY | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Westside Pediatric Group, LLP | 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.
-
- Legal Medicine
- Rochester, NY
- NPI 1649396573
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169683200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1498780800000",
"number": "1487700506",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "497 BEAHAN RD",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146243403",
"telephone_number": "585-247-5400",
"fax_number": "585-319-4124"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "497 BEAHAN RD",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146243403",
"telephone_number": "585-247-5400",
"fax_number": "585-319-4124"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "MICHAEL",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-25",
"last_updated": "2017-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "176492",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED CARE",
"identifier": "101264DL",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "4562184",
"identifier": "AETNA",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01172072",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS & BLUE SHIELD",
"identifier": "6550",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CHOICE",
"identifier": "010176492",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH NOW",
"identifier": "000922968001",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rochester, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.