Leonard J Green, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01027059A Issued in IN

Practice address

428 W Votaw St
Suite a
Portland, IN 47371-1302

Phone

(260) 726-8822

Fax

(260) 726-7857

NPI assigned

Mar 30, 2007

Last updated

Nov 15, 2010By 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 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

Practice roles

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.

• Family Practice of Jay County

  • Family Medicine Physician
  • Portland, IN
  • NPI 1982749867
  NPD (past)

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289779200000",
    "number": "1639299738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 710",
            "city": "PORTLAND",
            "state": "IN",
            "postal_code": "473710710",
            "telephone_number": "260-726-8822",
            "fax_number": "260-726-7857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "428 W VOTAW ST",
            "address_2": "SUITE A",
            "city": "PORTLAND",
            "state": "IN",
            "postal_code": "473711302",
            "telephone_number": "260-726-8822",
            "fax_number": "260-726-7857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "LEONARD",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-30",
        "last_updated": "2010-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01027059A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100253720",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Todd Gaerke
• Betsi Gagle
• Malcolm Christian George, D.D.S.
• Good Samaritan Mental Health Association LLC
• Stephanie Marie Gould, PHARMD
• Laura Ann Griffith, BSN
• Mark Allen Haggenjos, D.O.
• Anne Hardesty, NP
• Susan Hathaway
• Lyndia Renae Henson, NP

• Family Medicine Physician in Portland, IN
• Providers in Portland, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.