Active NPI
Eric Ross Green, CP
- Specialist
- Salt Lake City, UT
National Provider Identifier
1629391446
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- Practice address
- Fairfax Road at Virginia St.
Salt Lake City, UT 84103-4399 - Phone
- (801) 536-3820
- NPI assigned
- Mar 8, 2010
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | Primary |
Addresses
Primary practice location
Fairfax Road at Virginia St.
Salt Lake City, UT 84103-4399
Mailing address
Fairfax Road at Virginia St.
Salt Lake City, UT 84103-4399
Phone (801) 536-3820
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)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shriners Hospitals for Children | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinic/Center
- Aiea, HI
- NPI 1568299857
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1268006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268006400000",
"number": "1629391446",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "FAIRFAX ROAD AT VIRGINIA ST.",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841034399",
"telephone_number": "801-536-3820"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "FAIRFAX ROAD AT VIRGINIA ST.",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841034399",
"telephone_number": "801-536-3820"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "ERIC",
"middle_name": "ROSS",
"name_prefix": "Mr.",
"credential": "CP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-03-08",
"last_updated": "2010-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.