NPIMap

Individual provider Active NPI

Roddy D Green, MD

  • Family Medicine Physician
  • Keller, TX
National Provider Identifier
1801821780
Registry record updated Feb 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
L6054 Issued in TX
Practice address
100 Bourland Rd Ste 100
Keller, TX 76248-3591
Phone
(817) 379-5100
Fax
(817) 379-0479
NPI assigned
Jul 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X L6054 TX Primary

Addresses

Primary practice location

100 Bourland Rd Ste 100
Keller, TX 76248-3591

Mailing address

100 Bourland Rd Ste 100
Keller, TX 76248-3591
Phone (817) 379-5100

Other identifiers 3

IdentifierTypeStateIssuer
170258105MedicaidTX
170258101MedicaidTX
170258102MedicaidTX

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rgreen88560@Direct.TexasHealth.org Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040809000772 TX Practitioner - Family Practice 3577535756 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Texas Southwestern Medical School at Dallas, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Texas Health Physicians GroupGroup PAC ID 4385535954, 1,364 clinicians

Practice addresses (Care Compare)

100 Bourland Rd
Suite 150
Keller, TX 76248-3595
Phone (817) 753-6250

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Health Physicians Group Current Accepting new patients
Texas Health Physicians Group CurrentSince Jan 1, 2011 Accepting new patients
Texas Health Physicians Group Family Medicine CurrentSince Jan 1, 2011 Accepting new patients
Physicians and Allied Health Professionals Group, PA Family Medicine Past Accepting new patients

Locations

1600 Hospital Pkwy
Bedford, TX 76022
Phone (817) 355-7803

4333 N Josey Ln
Ste 104
Carrollton, TX 75010
Phone (972) 394-4500

100 Bourland Rd
Ste 100
Keller, TX 76248
Phone (817) 379-5100

100 Bourland Rd
Ste 150
Keller, TX 76248
Phone (817) 753-6250

891 Keller Pkwy
Ste 101A
Keller, TX 76248
Phone (817) 379-5100

341 Wheatfield Dr
Ste 100
Sunnyvale, TX 75182
Phone (972) 329-1996

Interoperability endpoints

  • Direct secure messaging: rgreen88560@direct.texashealth.org

Organizations & group practices 4

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645574400000",
    "number": "1801821780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 BOURLAND RD STE 100",
            "city": "KELLER",
            "state": "TX",
            "postal_code": "762483591",
            "telephone_number": "817-379-5100",
            "fax_number": "817-379-0479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BOURLAND RD STE 100",
            "city": "KELLER",
            "state": "TX",
            "postal_code": "762483591",
            "telephone_number": "817-379-5100",
            "fax_number": "817-379-0479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "RODDY",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2022-02-23",
        "certification_date": "2022-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "L6054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "170258105",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "170258101",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "170258102",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rgreen88560@Direct.TexasHealth.org",
            "affiliation": "N",
            "endpointDescription": "Health Information Exchange ( HIE)",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "100 Bourland Rd Ste 100",
            "city": "Keller",
            "state": "TX",
            "country_code": "US",
            "postal_code": "762483591",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Keller, TX

Sources for this page

Verify at the official NPI Registry.