Kelly D Green, M.D.

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

45891 Issued in TN

Practice address

145 Innovation Dr
Jackson, TN 38305-3019

Phone

(731) 422-0213

Fax

(731) 422-0409

NPI assigned

Apr 12, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Interventional CardiologyAlso: Cardiovascular Disease (Cardiology), Internal Medicine

Education

University of Tennessee, HSC, College of Medicine, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jackson Clinic PAGroup PAC ID 2668376872, 171 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Jackson-Madison County General Hospital Hospital, Jackson, TN, CCN 440002
• Baptist Memorial Hospital - Carroll County Hospital, Huntingdon, TN, CCN 440016
• Volunteer Community Hospital Hospital, Martin, TN, CCN 440061
• Hardin Medical Center Hospital, Savannah, TN, CCN 440109

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kellygreen@jcpa.allscriptsdirect.net

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.

• Jackson Clinic PA

  • Internal Medicine Physician
  • Jackson, TN
  • NPI 1285629386
  Medicare reassignment Care Compare group NPD
• Jackson Clinic PA

  • Durable Medical Equipment & Medical Supplies
  • Jackson, TN
  • NPI 1689443038
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Baptist Memorial Hospital-Huntingdon

  • General Acute Care Hospital
  • Huntingdon, TN
  • NPI 1710941356
  Care Compare affiliation
• Hardin County General Hospital

  • General Acute Care Hospital
  • Savannah, TN
  • NPI 1699754812
  Care Compare affiliation
• Jackson Madison County General Hospital

  • General Acute Care Hospital
  • Jackson, TN
  • NPI 1093705428
  Care Compare affiliation
• Martin Health

  • General Acute Care Hospital
  • Martin, TN
  • NPI 1275505372
  Care Compare affiliation

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698192000000",
    "number": "1790909489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 400",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383020400",
            "telephone_number": "731-425-5752",
            "fax_number": "731-425-5783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 INNOVATION DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383053019",
            "telephone_number": "731-422-0213",
            "fax_number": "731-422-0409"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 W Forest Ave",
            "address_2": "STE 300",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "TN",
            "postal_code": "383013937",
            "country_code": "US",
            "telephone_number": "731-422-0347",
            "fax_number": "731-422-0409",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREEN",
        "first_name": "KELLY",
        "middle_name": "D",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-12",
        "last_updated": "2023-10-25",
        "certification_date": "2022-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "TN",
            "license": "45891",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "45891",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1521978",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMC",
            "identifier": "P01391750",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "vumc@direct.vumc.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Health Information Service Provider",
            "address_1": "3601 The Vanderbilt Clinic",
            "city": "Nashville",
            "state": "TN",
            "country_code": "US",
            "postal_code": "372323937",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Debra M Grear, CASE MANAGER
• Great South Medical Inc.
• Deidre Green, MSW
• Diane Elaine Green, MD
• Euniquica Tanette Green
• Richard Earl Green Jr., MD
• Catherine M Greene, M.D.
• Kristi Greene, PT
• Greenleaf Homecare LLC
• Amy E Greer, FNP-C

• Cardiovascular Disease Physician in Jackson, TN
• Providers in Jackson, TN by specialty
• Cardiovascular Disease Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2023; 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.