NPIMap

Individual provider Active NPI

Patrick Green

  • Surgical Physician Assistant
  • Fairview, TX
National Provider Identifier
1497377642
Registry record updated Nov 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
11942053-1206 Issued in UT
Practice address
371 Oakwood TRL
Fairview, TX 75069-8722
Phone
(214) 926-2341
NPI assigned
May 11, 2020
Last updated
Nov 2, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 2, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 11942053-1206 UT Primary

Addresses

Primary practice location

371 Oakwood TRL
Fairview, TX 75069-8722

Mailing address

371 Oakwood TRL
Fairview, TX 75069-8722
Phone (214) 926-2341

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pgreen506424@direct.med.utah.edu Direct UNIVERSITY OF UTAH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210608003843 UT Practitioner - Physician Assistant 0648670992 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

175 N Medical Dr
University of Utah Department of NE
Salt Lake City, UT 84132-1103
Phone (801) 585-7575

50 N Medical Dr
Salt Lake City, UT 84132-0001

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.06 of 100Reported as group
Quality
77.8
Promoting interoperability
100
Improvement activities
40
Cost
65.74

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
11942053-1206UTMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Surgical Services CurrentSince May 1, 2021 Accepting new patients
University of Utah Acuity Care Services CurrentSince May 1, 2021 Accepting new patients
University of Utah Surgical Services Past Accepting new patients

Locations

127 S 500 E
Ste 400B
Salt Lake City, UT 84102
Phone (801) 587-6478

175 N Medical Dr
Slc, UT 84112
Phone (801) 581-6908

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

Interoperability endpoints

  • Direct secure messaging: pgreen506424@direct.med.utah.edu

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1589155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635811200000",
    "number": "1497377642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "371 OAKWOOD TRL",
            "city": "FAIRVIEW",
            "state": "TX",
            "postal_code": "750698722",
            "telephone_number": "214-926-2341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "371 OAKWOOD TRL",
            "city": "FAIRVIEW",
            "state": "TX",
            "postal_code": "750698722",
            "telephone_number": "214-926-2341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "PATRICK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-05-11",
        "last_updated": "2021-11-02",
        "certification_date": "2021-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "UT",
            "license": "11942053-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pgreen506424@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "UNIVERSITY OF UTAH",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fairview, TX

Sources for this page

Verify at the official NPI Registry.