Active NPI
Frederick Samuel Greene, PAC
- Physician Assistant
- Saint Paul Island, AK
National Provider Identifier
1639241110
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- AK212
- Practice address
- 1000 Polivenia Tpke
Saint Paul Island, AK 99660 - Phone
- (907) 546-8300
- NPI assigned
- Nov 14, 2006
- Last updated
- Jul 15, 2014
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | AK212 | AK | Primary |
Addresses
Primary practice location
1000 Polivenia Tpke
Saint Paul Island, AK 99660
Mailing address
PO Box 148
St Paul, AK 99660-0148
Phone (907) 546-8300
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
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 212 | AK | MD | Registered Dietitian |
| AK212 | AK | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southcentral Foundation | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405382400000",
"number": "1639241110",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 148",
"city": "ST PAUL",
"state": "AK",
"postal_code": "996600148",
"telephone_number": "907-546-8300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 POLIVENIA TPKE",
"city": "SAINT PAUL ISLAND",
"state": "AK",
"postal_code": "99660",
"telephone_number": "907-546-8300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREENE",
"first_name": "FREDERICK",
"middle_name": "SAMUEL",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-14",
"last_updated": "2014-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "AK",
"license": "AK212",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul Island, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.