NPIMap

Organization Active NPI

Green Country Medical, Inc

  • Family Medicine Physician
  • Nowata, OK
National Provider Identifier
1609998194
Registry record updated Jun 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
GREEN COUNTRY MEDICAL, INC
Practice address
712 E Osage Ave
Nowata, OK 74048-3638
Phone
(918) 273-0140
Fax
(918) 273-0147
NPI assigned
Apr 4, 2007
Last updated
Jun 21, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2018

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

Authorized official

Name
Sheryl NeelyNPI 1952641045
Title
RN
Phone
(918) 273-0140

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

712 E Osage Ave
Nowata, OK 74048-3638

Mailing address

712 E Osage Ave
Nowata, OK 74048-3638
Phone (918) 273-0140

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110602000398 OK Part B Supplier - Clinic/Group Practice 2668508615 Receives reassigned benefits from 1 practitioner
Practice locations: Nowata, OK

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Green Country Medical Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

712 E Osage Ave
Nowata, OK 74048
Phone (918) 273-0140

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529539200000",
    "number": "1609998194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "712 E OSAGE AVE",
            "city": "NOWATA",
            "state": "OK",
            "postal_code": "740483638",
            "telephone_number": "918-273-0140",
            "fax_number": "918-273-0147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 E OSAGE AVE",
            "city": "NOWATA",
            "state": "OK",
            "postal_code": "740483638",
            "telephone_number": "918-273-0140",
            "fax_number": "918-273-0147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN COUNTRY MEDICAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2018-06-21",
        "status": "A",
        "authorized_official_last_name": "NEELY",
        "authorized_official_first_name": "SHERYL",
        "authorized_official_title_or_position": "RN",
        "authorized_official_telephone_number": "918-273-0140"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nowata, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2018; 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.