Charles Green

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10005186A Issued in IN

Practice address

931 E 86TH St Ste 104
Indianapolis, IN 46240-1852

Phone

(317) 257-1484

Fax

(317) 257-1488

NPI assigned

Oct 1, 2024

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Michigan State University College of Osteopathic Medicine, 2025

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cgreen@drjohnson.emadirect.md

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.

• Dermatology Associates, P.C.

  • Specialist
  • Indianapolis, IN
  • NPI 1639483704
  Medicare reassignment NPD

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

{
    "created_epoch": "1727740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773187200000",
    "number": "1730907437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "931 E 86TH ST STE 104",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462401852",
            "telephone_number": "317-257-1484",
            "fax_number": "317-257-1488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "931 E 86TH ST STE 104",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462401852",
            "telephone_number": "317-257-1484",
            "fax_number": "317-257-1488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "CHARLES",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-10-01",
        "last_updated": "2026-03-11",
        "certification_date": "2026-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10005186A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cgreen@drjohnson.emadirect.md",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "931 E 86th St Ste 104",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462401852",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Benjamin Lawrence Green, MD
• Brenda Mae Green, MS CCC SLP
• Camille Green
• Camrie A Green, PA
• Carlee Green
• Dakota A Green
• Dawn Green
• Deanne Green, ATC
• Diamonique Green
• Frank J Green, MD

• Physician Assistant in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Physician Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2026; 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.

Verify at the official NPI Registry.