NPIMap

Organization Active NPI

Charles C Greene MD PHD PA

Doing business as Jacksonville ENT Surgery Center

  • Otolaryngology Physician
  • Jacksonville, FL
National Provider Identifier
1609125913
Registry record updated Jun 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
CHARLES C GREENE MD PHD PA
Doing business as
Jacksonville ENT Surgery Center
Practice address
6484 Fort Caroline Rd
Jacksonville, FL 32277-2042
Phone
(904) 419-2054
Fax
(904) 419-2057
NPI assigned
Aug 31, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2013

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

Authorized official

Name
Charles C GreeneNPI 1306876651
Title
Owner
Phone
(912) 691-5711

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Y00000X Primary

Addresses

Primary practice location

6484 Fort Caroline Rd
Jacksonville, FL 32277-2042

Mailing address

PO Box 864935
Orlando, FL 32886-4935
Phone (904) 419-2054

Other names 1

  • Jacksonville ENT Surgery Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130307000132 FL Part B Supplier - Clinic/Group Practice 2668627134 Receives reassigned benefits from 9 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jacksonville, FL

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
Charles C Greene MD PHD2 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.

Locations

3890 Dunn Ave
Ste 202
Jacksonville, FL 32218
Phone (904) 222-8658

6100 Kennerly Rd
Ste 102
Jacksonville, FL 32216
Phone (904) 419-2054

14444 Beach Blvd
Ste 28
Jacksonville Beach, FL 32250
Phone (904) 323-0954

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1346371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370304000000",
    "number": "1609125913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 864935",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328864935",
            "telephone_number": "904-419-2054",
            "fax_number": "904-419-2057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6484 FORT CAROLINE RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322772042",
            "telephone_number": "904-419-2054",
            "fax_number": "904-419-2057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES C GREENE MD PHD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-31",
        "last_updated": "2013-06-04",
        "status": "A",
        "authorized_official_last_name": "GREENE",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-691-5711"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jacksonville ENT Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.