Stacy Robin Green, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

DR.0050364 Issued in CO

Practice address

825 S Broadway St Ste 100
Boulder, CO 80305-5932

Phone

(303) 717-2521

NPI assigned

Apr 7, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Emergence Psychedelic Therapy, LLC

  • Clinic/Center
  • Boulder, CO
  • NPI 1407723497
  NPD Authorized official
• Stacy Green Enterprises, LLC

  • Health Service Clinic/Center
  • Boulder, CO
  • NPI 1871262253
  NPD Authorized official

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

{
    "created_epoch": "1270598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761091200000",
    "number": "1558686162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 S BROADWAY ST STE 100",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803055932",
            "telephone_number": "303-717-2521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 S BROADWAY ST STE 100",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803055932",
            "telephone_number": "303-717-2521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "STACY",
        "middle_name": "ROBIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-04-07",
        "last_updated": "2025-10-22",
        "certification_date": "2025-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0015X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychosomatic Medicine",
            "state": "CO",
            "license": "DR.0050364",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CO",
            "license": "DR.0050364",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina Marie Green, MA
• Daniel Green
• Justin D Green, M.D.
• Melissa Green
• Oleander Green, AUD
• Holly R Greenberg, MSW, LCSW
• Jalen Greene, RBT
• Julie K Greene, LPC
• Ben Greenfield
• Ellen M. Greenhouse, PH.D.

• General Practice Physician in Boulder, CO
• Providers in Boulder, CO by specialty
• General Practice Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.