Kevin Lee Green, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

3016 Issued in OK

Practice address

10221 E 81St St
Tulsa, OK 74133-4559

Phone

(918) 252-9300

NPI assigned

Dec 19, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Medical Resource Management, LLC

  • Urgent Care Clinic/Center
  • Edmond, OK
  • NPI 1104056365
  Medicare reassignment
• Tulsa Emergency Medical Center Inc

  • Urgent Care Clinic/Center
  • Tulsa, OK
  • NPI 1063479087
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1545177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545177600000",
    "number": "1497227151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2408 GALAXY RD",
            "city": "SAPULPA",
            "state": "OK",
            "postal_code": "740666800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10221 E 81ST ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741334559",
            "telephone_number": "918-252-9300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "KEVIN",
        "middle_name": "LEE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-12-19",
        "last_updated": "2018-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "3016",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hazel Jean Green
• Jessica Green, SLP
• Jessica Green
• Jordan Andrea Green, LCSW
• Julia Green
• Landin Green
• Michelle Green, PA-C
• Sara Elizabeth Green, PTA
• Shannon Green
• Stephanie S Green, APRN

• Physician Assistant in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.