Organization Active NPI

Greenside Prairies LLC

  • Clinical Social Worker
  • Edmond, OK
National Provider Identifier
1770466682
Registry record updated Jul 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
GREENSIDE PRAIRIES LLC
Practice address
3104 NW 184TH St
Edmond, OK 73012-9650
Phone
(405) 265-6142
NPI assigned
Jul 28, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2025

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

Authorized official

Name
Adam Daniel, LCSWNPI 1992374920
Title
Owner/Operator
Phone
(405) 265-6142

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

3104 NW 184TH St
Edmond, OK 73012-9650

Mailing address

3104 NW 184TH St
Edmond, OK 73012-9650

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251021000972 OK Part B Supplier - Clinic/Group Practice 5799273991 Receives reassigned benefits from 1 practitioner
Practice locations: Edmond, OK

National Provider Directory

National Provider Directory

Locations

1901 W 33rd St
Ste A2
Edmond, OK 73013
Phone (405) 265-6142

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1753660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753660800000",
    "number": "1770466682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3104 NW 184TH ST",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730129650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3104 NW 184TH ST",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730129650",
            "telephone_number": "405-265-6142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENSIDE PRAIRIES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-28",
        "last_updated": "2025-07-28",
        "certification_date": "2025-07-28",
        "status": "A",
        "authorized_official_last_name": "DANIEL",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "405-265-6142",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edmond, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2025; 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.