NPIMap

Individual provider Active NPI

Justin M Green, M.D.

  • Family Medicine Physician
  • W Amherst, NY
National Provider Identifier
1639525884
Registry record updated Jul 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
300292 Issued in NY
Practice address
3950 E Robinson Rd Ste 207
W Amherst, NY 14228-2044
Phone
(716) 564-1111
Fax
(716) 564-1128
NPI assigned
May 6, 2016
Last updated
Jul 22, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 300292 NY Primary

Addresses

Primary practice location

3950 E Robinson Rd Ste 207
W Amherst, NY 14228-2044

Mailing address

1150 Youngs Rd Ste 104
Williamsville, NY 14221-8096
Phone (716) 636-7990

Other practice location 1

77 Goodell St Ste 240
Buffalo, NY 14203-1243
Phone (716) 816-7280

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191008002629 NY Practitioner - Family Practice 8123365590 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Highgate Medical Group PCGroup PAC ID 6901885565, 58 clinicians

Practice addresses (Care Compare)

6255 Sheridan Dr
Williamsville, NY 14221-4825
Phone (716) 636-7979

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
300292NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Highgate Medical Group Family Medicine CurrentSince Sep 23, 2019 Accepting new patients
Highgate Medical Group CurrentSince Nov 13, 2022 Accepting new patients
Harris Hill Nursing Facility, LLC Past Accepting new patients
Absolut Center for Nursing and Rehabilitation at Aurora Park, LLC Past Accepting new patients
Autumn View Health Care Facility LLC PastSince Sep 5, 2019 Accepting new patients

Locations

3950 E Robinson Rd
Ste 207
West Amherst, NY 14228
Phone (716) 564-1111

3950 E Robinson Rd
Ste 305
West Amherst, NY 14228

1150 Youngs Rd
Ste 104
Williamsville, NY 14221
Phone (716) 636-7979

6255 Sheridan Dr
Williamsville, NY 14221
Phone (716) 630-2582

6255 Sheridan Dr
Ste 200
Williamsville, NY 14221
Phone (716) 564-1111

Interoperability endpoints

  • Direct secure messaging: jgreen@highgatemedical.medentdirect.com

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
The Bonadio GroupEast Aurora, NY, CCN 335281 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Nov 1, 2022
Nov 1, 2022
Autumn View Health Care Facility LLCHamburg, NY, CCN 335662 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2025
Feb 4, 2025

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1462492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563753600000",
    "number": "1639525884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 YOUNGS RD STE 104",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142218096",
            "telephone_number": "716-636-7990",
            "fax_number": "716-636-7993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 E ROBINSON RD STE 207",
            "city": "W AMHERST",
            "state": "NY",
            "postal_code": "142282044",
            "telephone_number": "716-564-1111",
            "fax_number": "716-564-1128"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "77 Goodell St Ste 240",
            "address_purpose": "LOCATION",
            "city": "Buffalo",
            "state": "NY",
            "postal_code": "142031243",
            "country_code": "US",
            "telephone_number": "716-816-7280",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREEN",
        "first_name": "JUSTIN",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-06",
        "last_updated": "2019-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "300292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in W Amherst, NY

Sources for this page

Verify at the official NPI Registry.