Louis Mayer Green, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

131887 Issued in NY

Practice address

1001 W Fayette St
Suite 400
Syracuse, NY 13204-2859

Phone

(315) 472-1488

Fax

(315) 472-8060

NPI assigned

Jun 15, 2005

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Crouse Medical Practice PLLC

  • Clinical Medical Laboratory
  • Syracuse, NY
  • NPI 1548579212
  NPD (past)

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

{
    "created_epoch": "1118793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476403200000",
    "number": "1780689091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "739 IRVING AVE",
            "address_2": "STE 200",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101668",
            "telephone_number": "315-479-5070",
            "fax_number": "315-701-2550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 W FAYETTE ST",
            "address_2": "SUITE 400",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132042859",
            "telephone_number": "315-472-1488",
            "fax_number": "315-472-8060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "LOUIS",
        "middle_name": "MAYER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-15",
        "last_updated": "2016-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "131887",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00625434",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dennis Green
• Gary Randall Green, MD
• Heather L Green, NP
• Heather L Green
• Kenneth R. Green, M.D.
• Stacey R Green, LPN
• Stephanie E Green, LPN
• Thane R Green
• Thomas G Green, MD
• Timika Nicole Green, LPN

• Internal Medicine Physician in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.