NPIMap

Organization Active NPI

Green Clinic LLC

  • Family Medicine Physician
  • Ruston, LA
National Provider Identifier
1831178755
Registry record updated Oct 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
GREEN CLINIC LLC
Practice address
1200 S Farmerville St
Ruston, LA 71270-5941
Phone
(318) 255-3690
NPI assigned
Jan 10, 2006
Last updated
Oct 22, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2026

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

Authorized official

Name
Clayton Lee Norman
Title
Administrator
Phone
(318) 251-6343

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician 204C00000X
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X
Dermatology Physician 207N00000X
Family Medicine Physician 207Q00000X Primary
Internal Medicine Physician 207R00000X
Nuclear Medicine Physician 207U00000X
Obstetrics & Gynecology Physician 207V00000X
Ophthalmology Physician 207W00000X
Orthopaedic Surgery Physician 207X00000X
Otolaryngology Physician 207Y00000X
Pediatrics Physician 208000000X
Physical Medicine & Rehabilitation Physician 208100000X
Preventive Medicine/Occupational Environmental Medicine Physician 2083P0500X
Podiatrist 213E00000X

Addresses

Primary practice location

1200 S Farmerville St
Ruston, LA 71270-5941

Mailing address

1200 S Farmerville St
Ruston, LA 71270-5941
Phone (318) 255-3690

Other practice location 1

411 E Vaughn Ave Ste 103
Ruston, LA 71270-5975
Phone (318) 255-9414

Other practice location 2

620 E College St
Homer, LA 71040-3202
Phone (318) 927-2024

Other practice location 3

411 E Vaughn Ave Ste 200
Ruston, LA 71270-5977
Phone (318) 232-1570

Other practice location 4

1420 Commerce St
Ruston, LA 71270-6653
Phone (318) 255-3762

Other practice location 5

4707 Quitman Hwy
Hodge, LA 71247
Phone (318) 395-1168

Other identifiers 4

IdentifierTypeStateIssuer
1006858MedicaidLA
CS0281OtherLARR MEDICARE GROUP
06185OtherLABCBS GROUP
=========OtherLABCBS GROUP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040616000177 LA Part B Supplier - Clinic/Group Practice 4789668831 Receives reassigned benefits from 39 practitioners
1 other NPI on this enrollment
Practice locations: Jonesboro, LA; Minden, LA; Ruston, LA
O20100930073075 LA DME Supplier - Multi-Specialty - PhysicianDME Supplier - Physician - Unknown Physician Specialty 4789668831 Practice locations: Ruston, LA

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D1026659Green Clinic Jonesboro4707 Quitman Highway, Hodge, LA 71247Certificate of waiverJun 9, 2028
19D1044231Green Clinic Northside1402 Celebrity Drive, Ruston, LA 71270Certificate of waiverAug 14, 2027
19D2107593Green Clinic-Landon Smith, MD411 East Vaughn, Suite 103, Ruston, LA 71270Provider-performed microscopyMar 14, 2028
19D2321927Green Clinic Surgery411 E Vaughn Suite 200, Ruston, LA 71270Certificate of waiverApr 12, 2027

National Provider Directory

National Provider Directory

Locations

1200 S Farmerville St
Ruston, LA 71270
Phone (318) 251-6103

Practitioners & affiliated clinicians

Practitioners 63

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 63

NPI Registry JSON

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

{
    "created_epoch": "1136851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792627200000",
    "number": "1831178755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 S FARMERVILLE ST",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712705941",
            "telephone_number": "318-255-3690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 S FARMERVILLE ST",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712705941",
            "telephone_number": "318-255-3690"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "411 E Vaughn Ave Ste 103",
            "address_purpose": "LOCATION",
            "city": "Ruston",
            "state": "LA",
            "postal_code": "712705975",
            "country_code": "US",
            "telephone_number": "318-255-9414",
            "fax_number": "318-255-9434",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "620 E College St",
            "address_purpose": "LOCATION",
            "city": "Homer",
            "state": "LA",
            "postal_code": "710403202",
            "country_code": "US",
            "telephone_number": "318-927-2024",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "411 E Vaughn Ave Ste 200",
            "address_purpose": "LOCATION",
            "city": "Ruston",
            "state": "LA",
            "postal_code": "712705977",
            "country_code": "US",
            "telephone_number": "318-232-1570",
            "fax_number": "318-251-6230",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1420 Commerce St",
            "address_purpose": "LOCATION",
            "city": "Ruston",
            "state": "LA",
            "postal_code": "712706653",
            "country_code": "US",
            "telephone_number": "318-255-3762",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4707 Quitman Hwy",
            "address_purpose": "LOCATION",
            "city": "Hodge",
            "state": "LA",
            "postal_code": "71247",
            "country_code": "US",
            "telephone_number": "318-395-1168",
            "fax_number": "318-395-1170",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GREEN CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-10",
        "last_updated": "2026-10-22",
        "certification_date": "2026-10-22",
        "status": "A",
        "authorized_official_last_name": "NORMAN",
        "authorized_official_first_name": "CLAYTON",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "318-251-6343"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "204C00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207U00000X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2083P0500X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1006858",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GROUP",
            "identifier": "CS0281",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP",
            "identifier": "06185",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP",
            "identifier": "=========",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ruston, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.