Active NPI
Rebecca Green
- Clinical Psychologist
- Chattanooga, TN
National Provider Identifier
1700328796
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- P-3323
- Practice address
- 1815 McCallie Ave
Chattanooga, TN 37404-3026 - Phone
- (423) 756-2894
- Fax
- (423) 756-2899
- NPI assigned
- Nov 8, 2016
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | P-3323 | TN | Primary |
Addresses
Primary practice location
1815 McCallie Ave
Chattanooga, TN 37404-3026
Mailing address
1815 McCallie Ave
Chattanooga, TN 37404-3026
Phone (423) 756-2894
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180524001611 | TN | Practitioner - Clinical Psychologist | 1355606278 | Reassigns benefits to 4 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Brownsville Medical Clinic, P.a.BH Services Southeast 1 PC
Practice addresses (Care Compare)
2565 N Washington Ave
Brownsville, TN 38012-1610
Merit-based Incentive Payment System (MIPS)
- Final score
- 89.72 of 100
- Quality
- 72.97
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P-3323 | TN | MD | Clinical Psychologist |
| 3323 | TN | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CS Pacs 3 Southeast, LLC | Current | Accepting new patients | |
| Ipc Pac Healthcare Services of Tennessee PC | Current | Accepting new patients | |
| NV Pacs 2 LLC | Current | Accepting new patients | |
| BH Services Southeast 1 PC | Current | Accepting new patients |
Locations
18 N Cavalier Dr
Alamo, TN 38001
Phone (731) 696-4500
880 S Mohawk Dr
Erwin, TN 37650
Phone (423) 743-7669
Organizations & group practices 6
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.
-
- Internal Medicine Physician
- Bristol, TN
- NPI 1104277656
TN
-
- Rural Health Clinic/Center
- Brownsville, TN
- NPI 1386488922
-
- Rural Health Clinic/Center
- Alamo, TN
- NPI 1568200806
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1478563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478563200000",
"number": "1700328796",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1815 MCCALLIE AVE",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "374043026",
"telephone_number": "423-756-2894",
"fax_number": "423-756-2899"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1815 MCCALLIE AVE",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "374043026",
"telephone_number": "423-756-2894",
"fax_number": "423-756-2899"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "REBECCA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-11-08",
"last_updated": "2016-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TN",
"license": "P-3323",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chattanooga, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.