NPIMap

Organization Active NPI

Mary Kelly Green MD PLLC

  • Ophthalmology Physician
  • Marble Falls, TX
National Provider Identifier
1689947509
Registry record updated Feb 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
MARY KELLY GREEN MD PLLC
Practice address
204 Gateway N
Suite a
Marble Falls, TX 78654-6361
Phone
(830) 698-5868
Fax
(830) 798-8017
NPI assigned
Feb 23, 2012
Last updated
Feb 24, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2012

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

Authorized official

Name
Mary K. Green, MDNPI 1487835617
Title
Owner
Phone
(830) 693-5868

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X TX
Ophthalmology Physician 207W00000X TX Primary

Addresses

Primary practice location

204 Gateway N
Suite a
Marble Falls, TX 78654-6361

Mailing address

204 Gateway N
Suite a
Marble Falls, TX 78654-6361
Phone (830) 698-5868

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120426000503 TX Part B Supplier - Clinic/Group Practice 9133381726 Receives reassigned benefits from 5 practitioners
Practice locations: Burnet, TX; Marble Falls, TX

National Provider Directory

National Provider Directory

Interoperability endpoints

  • Direct secure messaging: jsantamaria@mkgreen.intellechartdirect.net

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1329955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330041600000",
    "number": "1689947509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 GATEWAY N",
            "address_2": "SUITE A",
            "city": "MARBLE FALLS",
            "state": "TX",
            "postal_code": "786546361",
            "telephone_number": "830-698-5868",
            "fax_number": "830-798-8017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 GATEWAY N",
            "address_2": "SUITE A",
            "city": "MARBLE FALLS",
            "state": "TX",
            "postal_code": "786546361",
            "telephone_number": "830-698-5868",
            "fax_number": "830-798-8017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY KELLY GREEN MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-23",
        "last_updated": "2012-02-24",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "830-693-5868",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marble Falls, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.