Greene Berry Colvin IV, MD

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

15739 Issued in MS

Practice address

7164 Hacks Cross Rd Ste 106
Olive Branch, MS 38654-3919

Phone

(662) 895-6455

Fax

(662) 895-6460

NPI assigned

Aug 10, 2006

Last updated

Feb 8, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

0 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

0

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gcolvin26255@mlh.direct-ci.com
• Direct secure messaging: greenecolvin@desoto-ent.directglo.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Desoto Ear, Nose &Throat

  • Otolaryngology Physician
  • Olive Branch, MS
  • NPI 1477644045
  Medicare reassignment NPD Authorized official
• Family Ear Nose & Throat Care

  • Pediatric Otolaryngology Physician
  • Southaven, MS
  • NPI 1477541670
  NPD (past)

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644278400000",
    "number": "1619988243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7164 HACKS CROSS RD STE 106",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386543919",
            "telephone_number": "662-895-6455",
            "fax_number": "662-895-6460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7164 HACKS CROSS RD STE 106",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386543919",
            "telephone_number": "662-895-6455",
            "fax_number": "662-895-6460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLVIN",
        "first_name": "GREENE",
        "middle_name": "BERRY",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-10",
        "last_updated": "2022-02-08",
        "certification_date": "2020-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "TN",
            "license": "MD0000030098",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MS",
            "license": "15739",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0119469",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chiropractic Evolved LLC
• City of Olive Branch (Olive Branch Fire Dept. Ambulance)
• Heather Nicole Clayton, LPC
• Latoya Cole, NCC
• Karissa Diane Coleman, LPC
• Alisha Gholston Comer, MS,CCC-SLP
• Comprehensive Stafffing Services
• Confident Living LLC
• Julia Conner-Mendez, NP
• Kylee Alexis Cook, APRN, FNP-C

• Otolaryngology Physician in Olive Branch, MS
• Providers in Olive Branch, MS by specialty
• Otolaryngology Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.