Active NPI
Ryan Mark Green, ATC
- Athletic Trainer
- Mandeville, LA
National Provider Identifier
1508262395
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 2021 Claiborne St
Mandeville, LA 70448-5804 - Phone
- (985) 624-8200
- NPI assigned
- Nov 6, 2014
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Primary |
Addresses
Primary practice location
2021 Claiborne St
Mandeville, LA 70448-5804
Mailing address
14488 Lake Tahoe Dr
Covington, LA 70433-6951
Phone (225) 810-9058
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1415232000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1415232000000",
"number": "1508262395",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14488 LAKE TAHOE DR",
"city": "COVINGTON",
"state": "LA",
"postal_code": "704336951",
"telephone_number": "225-810-9058"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2021 CLAIBORNE ST",
"city": "MANDEVILLE",
"state": "LA",
"postal_code": "704485804",
"telephone_number": "985-624-8200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "RYAN",
"middle_name": "MARK",
"name_prefix": "Dr.",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-11-06",
"last_updated": "2014-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mandeville, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.