Active NPI
Mark Allen Green, D.C.
- Chiropractor
- Louisville, KY
National Provider Identifier
1609968544
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 3776
- Practice address
- 2137 Dixie Hwy
Louisville, KY 40210-2242 - Phone
- (502) 561-0490
- Fax
- (502) 409-4964
- NPI assigned
- Sep 28, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 3776 | KY | Primary |
| Chiropractor | 111N00000X | 08001343 | IN |
Addresses
Primary practice location
2137 Dixie Hwy
Louisville, KY 40210-2242
Mailing address
7716 Barbour Place Dr
Louisville, KY 40241-2730
Phone (502) 561-0490
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000051525 | Other | KY | ANTHEM # |
| 50008078 | Other | KY | PASSPORT PROVIDER # |
| 85001758 | Medicaid | KY | |
| 2623859000 | Other | KY | PASSPORT ADVANTAGE ID# |
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 |
|---|---|---|---|
| 08001343 | IN | MD | Chiropractor |
| 3776 | KY | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1351555200000",
"number": "1609968544",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7716 BARBOUR PLACE DR",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402412730",
"telephone_number": "502-561-0490",
"fax_number": "502-409-4964"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2137 DIXIE HWY",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402102242",
"telephone_number": "502-561-0490",
"fax_number": "502-409-4964"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "MARK",
"middle_name": "ALLEN",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-28",
"last_updated": "2012-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "KY",
"license": "3776",
"primary": true
},
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "IN",
"license": "08001343",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM #",
"identifier": "000000051525",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PASSPORT PROVIDER #",
"identifier": "50008078",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "85001758",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PASSPORT ADVANTAGE ID#",
"identifier": "2623859000",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.