Active NPI
Cynthia K. Green, ED DIETITIAN
- Registered Dietitian
- Gonzales, TX
National Provider Identifier
1568565497
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 862948
- Practice address
- 1110 N Sarah Dewitt Dr
Gonzales, TX 78629-3311 - Phone
- (830) 672-7581
- Fax
- (830) 672-2401
- NPI assigned
- Sep 6, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 862948 | TX | Primary |
Addresses
Primary practice location
1110 N Sarah Dewitt Dr
Gonzales, TX 78629-3311
Mailing address
1110 N Sarah Dewitt Dr
Gonzales, TX 78629-3311
Phone (830) 672-7581
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3460982 | Medicaid | TX | |
| 00L70B | Other | TX | MEDICARE GROUP NUMBER |
| 862948 | Other | TX | DIETETIC REGISTRATION |
| DT05451 | Other | TX | LICENSED DIETITIAN |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 862948 | TX | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1482883200000",
"number": "1568565497",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1110 N SARAH DEWITT DR",
"city": "GONZALES",
"state": "TX",
"postal_code": "786293311",
"telephone_number": "830-672-7581",
"fax_number": "830-672-2401"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1110 N SARAH DEWITT DR",
"city": "GONZALES",
"state": "TX",
"postal_code": "786293311",
"telephone_number": "830-672-7581",
"fax_number": "830-672-2401"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "CYNTHIA",
"middle_name": "K.",
"name_prefix": "Ms.",
"credential": "ED DIETITIAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-06",
"last_updated": "2016-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "TX",
"license": "862948",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3460982",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP NUMBER",
"identifier": "00L70B",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DIETETIC REGISTRATION",
"identifier": "862948",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSED DIETITIAN",
"identifier": "DT05451",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gonzales, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.