Ted Allen Green, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

106508 Issued in MO

Practice address

515 N Virginia Ave
Eureka, MO 63025-1115

Phone

(636) 587-3000

Fax

(636) 587-2243

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: tgreen@eurekapediatrics.opdirect.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.

• Eureka Pediatrics

  • Pediatrics Physician
  • Eureka, MO
  • NPI 1578758470
  NPD (past) Authorized official

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1831200476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 N VIRGINIA AVE",
            "city": "EUREKA",
            "state": "MO",
            "postal_code": "630251115",
            "telephone_number": "636-587-3000",
            "fax_number": "636-587-2243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 N VIRGINIA AVE",
            "city": "EUREKA",
            "state": "MO",
            "postal_code": "630251115",
            "telephone_number": "636-587-3000",
            "fax_number": "636-587-2243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "TED",
        "middle_name": "ALLEN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "106508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gateway Spine LLC
• Amanda Marie Gilman, MSW, LCSW
• Heather D Gjorgjievski, D.O.
• Clifton Glore, LCSW
• Caleb Paul Gorman, DC
• Jack Dean Griffin Jr., DMD PC FAGD
• Tara Han, OTD, OTR/L
• Geralda F Hancock, DC
• James Dale Harris, MPT
• Gisoo Hashemi, RPH

• Pediatrics Physician in Eureka, MO
• Providers in Eureka, MO by specialty
• Pediatrics Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.