Active NPI
Otis Green
- Emergency Medicine Physician
- Jacksonville, FL
National Provider Identifier
1497326300
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- ME180065
- Practice address
- 4201 Belfort Rd
Jacksonville, FL 32216-1431 - Phone
- (904) 296-3700
- NPI assigned
- Jul 2, 2021
- 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 |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | ME180065 | FL | Primary |
Addresses
Primary practice location
4201 Belfort Rd
Jacksonville, FL 32216-1431
Mailing address
1601 Cummins Dr Ste D
Modesto, CA 95358-6411
Other practice location 1
8083 Parramore Rd
Jacksonville, FL 32244-5703
Phone (904) 450-6760
Other practice location 2
205 Trinity Way
Saint Johns, FL 32259-1155
Phone (904) 450-8120
Other practice location 3
9820 Hutchinson Park Dr
Jacksonville, FL 32225-7205
Phone (904) 450-8120
Other practice location 4
1670 St Vincents Way
Middleburg, FL 32068-8447
Phone (904) 602-1000
Other practice location 5
1 Shircliff Way
Jacksonville, FL 32204-4748
Phone (904) 308-7000
Other practice location 6
720 Westview Dr SW
Atlanta, GA 30310-1458
Phone (404) 752-1500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Emergency Medicine
- Education
- Morehouse School of Medicine, 2022
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1601 Cummins Dr
Suite D
Modesto, CA 95358-6403
655 W 8TH St
Jacksonville, FL 32209-6511
Hospital & facility affiliations
- Ascension St Vincent'S Riverside
- Ascension St Vincent'S Clay County
- Baptist Health Medical Center - Jacksonville
- Ascension St Vincent'S Southside
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME180065 | FL | MD | Emergency Medicine Physician |
Interoperability endpoints
- ogreen537820@direct.shands.ufl.edu
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.
-
- Emergency Medicine Physician
- Miramar Beach, FL
- NPI 1295442614
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Jacksonville, FL
- NPI 1578620449
-
- General Acute Care Hospital
- Jacksonville, FL
- NPI 1396926747
-
- General Acute Care Hospital
- Jacksonville, FL
- NPI 1134117575
-
- General Acute Care Hospital
- Middleburg, FL
- NPI 1457690471
-
- Clinical Medical Laboratory
- Jacksonville, FL
- NPI 1669556072
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1625184000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1774828800000",
"number": "1497326300",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1601 CUMMINS DR STE D",
"city": "MODESTO",
"state": "CA",
"postal_code": "953586411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4201 BELFORT RD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322161431",
"telephone_number": "904-296-3700"
}
],
"practiceLocations": [
{
"address_1": "8083 Parramore Rd",
"address_purpose": "LOCATION",
"city": "Jacksonville",
"state": "FL",
"postal_code": "322445703",
"country_code": "US",
"telephone_number": "904-450-6760",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "205 Trinity Way",
"address_purpose": "LOCATION",
"city": "Saint Johns",
"state": "FL",
"postal_code": "322591155",
"country_code": "US",
"telephone_number": "904-450-8120",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "9820 Hutchinson Park Dr",
"address_purpose": "LOCATION",
"city": "Jacksonville",
"state": "FL",
"postal_code": "322257205",
"country_code": "US",
"telephone_number": "904-450-8120",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1670 St Vincents Way",
"address_purpose": "LOCATION",
"city": "Middleburg",
"state": "FL",
"postal_code": "320688447",
"country_code": "US",
"telephone_number": "904-602-1000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1 Shircliff Way",
"address_purpose": "LOCATION",
"city": "Jacksonville",
"state": "FL",
"postal_code": "322044748",
"country_code": "US",
"telephone_number": "904-308-7000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "720 Westview Dr SW",
"address_purpose": "LOCATION",
"city": "Atlanta",
"state": "GA",
"postal_code": "303101458",
"country_code": "US",
"telephone_number": "404-752-1500",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GREEN",
"first_name": "OTIS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-07-02",
"last_updated": "2026-03-30",
"certification_date": "2026-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "FL",
"license": "ME180065",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2026; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.