Jack L Greenberg, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G14072 Issued in CA

Practice address

340 W Central Ave
Suite 102B
Brea, CA 92821-3006

Phone

(714) 671-7830

Fax

(714) 671-1004

NPI assigned

May 21, 2007

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508075193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1070 E KNOLLCREST DR",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917243430",
            "telephone_number": "626-339-8341",
            "fax_number": "626-332-7031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 W CENTRAL AVE",
            "address_2": "SUITE 102B",
            "city": "BREA",
            "state": "CA",
            "postal_code": "928213006",
            "telephone_number": "714-671-7830",
            "fax_number": "714-671-1004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREENBERG",
        "first_name": "JACK",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G14072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grace Grannis, PT, DPT
• Grant Me the Courage Recovery
• Kimberly Danielle Grayson
• Thomas Marks Green, DDS
• Barbara L Greenberg, M.D.
• William J. Greene, D.C,,QME
• Jim S Grimes, PSY.D.
• Marc A. Grossman, M.D.
• Karen Guern, PTA
• Guided Solutions Therapy, Sex, Marriage and Family Counseling P.C.

• Family Medicine Physician in Brea, CA
• Providers in Brea, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.