Active NPI
Charles Perry Green
- Community Health Worker
- Kamiah, ID
National Provider Identifier
1811266927
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 003866467
- Practice address
- 3361 No Kid Rd
Kamiah, ID 83536-5002 - Phone
- (208) 553-0284
- Fax
- (208) 935-2329
- NPI assigned
- Dec 19, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 003866467 | ID | Primary |
Addresses
Primary practice location
3361 No Kid Rd
Kamiah, ID 83536-5002
Mailing address
3361 No Kid Rd
Kamiah, ID 83536-5002
Phone (208) 553-0284
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003866467 | ID | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1324252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1324252800000",
"number": "1811266927",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3361 NO KID RD",
"city": "KAMIAH",
"state": "ID",
"postal_code": "835365002",
"telephone_number": "208-553-0284",
"fax_number": "208-935-2329"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3361 NO KID RD",
"city": "KAMIAH",
"state": "ID",
"postal_code": "835365002",
"telephone_number": "208-553-0284",
"fax_number": "208-935-2329"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "CHARLES",
"middle_name": "PERRY",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-12-19",
"last_updated": "2011-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "ID",
"license": "003866467",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kamiah, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.