Individual provider Active NPI

Daniel Dale Greene, PA-C

  • Physician Assistant
  • Cedar City, UT
National Provider Identifier
1609076926
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10231439-1206 Issued in UT
Practice address
1303 N Main St
Cedar City, UT 84721-9746
Phone
(435) 868-5000
NPI assigned
Jul 24, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1077676 NE
Physician Assistant 363A00000X 10231439-1206 UT Primary

Addresses

Primary practice location

1303 N Main St
Cedar City, UT 84721-9746

Mailing address

PO Box 30180
Salt Lake City, UT 84130-0180
Phone (801) 442-4265

Other practice location 1

8091 Georgia Ave
Bldg 3504
Fort Polk, LA 71459-5468
Phone (337) 531-0289

Other practice location 2

8091 Georgia Ave
Bldg 3504
Fort Polk, LA 71459-5468
Phone (337) 531-0289

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171127001583 UT Practitioner - Physician Assistant 1052446358 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Robert D Pearson PCGroup PAC ID 6204083975, 2 clinicians
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

1251 Northfield Rd
Suite 200
Cedar City, UT 84721-8623
Phone (435) 867-8719

1303 N Main St
Cedar City, UT 84721-9746

1380 E Medical Ctr Dr
St George, UT 84790-2123
Phone (435) 251-1000

Hospital & facility affiliations

  • Intermountain Health Cedar City Hospital Hospital, Cedar City, UT, CCN 460007

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1077676NEMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services Inc CurrentSince Jun 1, 2017 Accepting new patients
Ihc Health Services, Inc. CurrentSince Jun 1, 2017 Accepting new patients

Locations

1303 N Main St
Cedar City, UT 84721
Phone (435) 586-2229

1380 E Medical Center Dr
St George, UT 84790
Phone (435) 251-2992

1380 E Medical Center Dr
#P
St George, UT 84790
Phone (435) 251-2355

Interoperability endpoints

  • Direct secure messaging: dan@cedarcityent.emadirect.md

Organizations & group practices 4

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1185235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1609076926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30180",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841300180",
            "telephone_number": "801-442-4265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1303 N MAIN ST",
            "city": "CEDAR CITY",
            "state": "UT",
            "postal_code": "847219746",
            "telephone_number": "435-868-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8091 Georgia Ave",
            "address_2": "Bldg 3504",
            "address_purpose": "LOCATION",
            "city": "Fort Polk",
            "state": "LA",
            "postal_code": "714595468",
            "country_code": "US",
            "telephone_number": "337-531-0289",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8091 Georgia Ave",
            "address_2": "Bldg 3504",
            "address_purpose": "LOCATION",
            "city": "Fort Polk",
            "state": "LA",
            "postal_code": "714595468",
            "country_code": "US",
            "telephone_number": "337-531-0289",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREENE",
        "first_name": "DANIEL",
        "middle_name": "DALE",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-24",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "1077676",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "10231439-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cedar City, UT

Sources for this page

Verify at the official NPI Registry.