Green Clinic LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

GREEN CLINIC LLC

Practice address

1809 Northpointe LN Ste 102
Ruston, LA 71270-3852

Phone

(318) 255-3762

NPI assigned

Mar 4, 2019

Organization subpart

No

Name

Christopher Anding Stegall

Title

Cfo

Phone

(318) 251-6304

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Green Clinic LLC

  • Family Medicine Physician
  • Ruston, LA
  • NPI 1831178755

  O20040616000177

  Same enrollment

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Green Clinic LLC

  • Family Medicine Physician
  • Ruston, LA
  • NPI 1831178755

  4789668831

  Same PAC ID
• Green Clinic LLC

  • Physical Therapy Clinic/Center
  • Ruston, LA
  • NPI 1891801601

  4789668831

  Same PAC ID

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kristina D Barber, NP

  • Family Nurse Practitioner
  • Ruston, LA
  • NPI 1043801954
  Care Compare group NPD
• Cody Blackwelder, MD

  • Surgery Physician
  • Ruston, LA
  • NPI 1548824873
  Care Compare group NPD
• Mark Blackwelder, M.D.

  • Internal Medicine Physician
  • Ruston, LA
  • NPI 1245200880
  Care Compare group NPD
• Kerry Wayne Byrnes, M.D.

  • Surgery Physician
  • Ruston, LA
  • NPI 1982787099
  Care Compare group NPD
• Wesley Coleman

  • Physician Assistant
  • Alexandria, LA
  • NPI 1124492137
  Care Compare group NPD
• Cleo 'Trey' Deason, N.P.

  • Family Nurse Practitioner
  • Monroe, LA
  • NPI 1881077808
  Care Compare group NPD
• Michael E Ehrlich, M.D.

  • Neurology Physician
  • Ruston, LA
  • NPI 1780654186
  Care Compare group NPD
• Lisa Marie Farris, APRN, FNP

  • Family Nurse Practitioner
  • Ruston, LA
  • NPI 1700385622
  Care Compare group NPD
• Robert Railey Garrett, FNP

  • Nurse Practitioner
  • Ruston, LA
  • NPI 1992162622
  Care Compare group NPD
• Raymond Dewie Germany Jr., MD

  • Urology Physician
  • Shreveport, LA
  • NPI 1649275116
  Care Compare group NPD
• Robin Renee Hart Smith, APRN

  • Family Nurse Practitioner
  • Monroe, LA
  • NPI 1346612173
  Care Compare group NPD
• Michael Kyle Hendricks, PA-C

  • Physician Assistant
  • Monroe, LA
  • NPI 1205196805
  Care Compare group NPD

Medicare fee-for-service enrollment

Enrolled in LA2 enrollments

Enrollment records 2

Rural health clinic certification: CCN 193963

Legal name

GREEN CLINIC LLC

Doing business as

QUICKCARE OF RUSTON

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Jun 23, 2020

Last certification

Jun 30, 2023

Ownership / control type

1B

Organization structure

LLCProprietary

Incorporated

in LA

Enrollment address

1420 Commerce St
Ste 1
Ruston, LA 71270-6653

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Tax ID family

Green Clinic LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Green Clinic LLC

  • Community/Retail Pharmacy
  • Ruston, LA
  • NPI 1275632036
  NPD tax ID

Locations

• QUICKCARE OF RUSTON Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 4, 2019.

{
    "created_epoch": "1551657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551657600000",
    "number": "1578021093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 S FARMERVILLE ST",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712705941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1809 NORTHPOINTE LN STE 102",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712703852",
            "telephone_number": "318-255-3762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-04",
        "last_updated": "2019-03-04",
        "status": "A",
        "authorized_official_last_name": "STEGALL",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "ANDING",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "318-251-6304"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "QUICKCARE OF RUSTON",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alexis Gray, RD, LDN
• Latrice Gray
• Rel Larkin Gray, MD
• Green Clinic LLC
• Green Clinic LLC
• Green Clinic LLC
• Green Clinic LLC
• Green Clinic Surgical Center
• Green Clinic Surgical Hospital Crna Group
• Green Clinic Surgical Hospital, LLC

• All providers in Ruston, LA
• Rural Health Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.