Landen Bradley Green, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

20A20171 Issued in CA

Practice address

1467 Ford St Ste 201
Redlands, CA 92373-3912

Phone

(909) 206-2612

Fax

(909) 488-7373

NPI assigned

Jun 26, 2019

Sex

Male

Sole proprietor

No

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

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.

Opted out of Medicare

Previously, effective Aug 18, 2022 through Aug 18, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1561507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717718400000",
    "number": "1841851185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 N 4TH ST",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170465606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1467 FORD ST STE 201",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923733912",
            "telephone_number": "909-206-2612",
            "fax_number": "909-488-7373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "LANDEN",
        "middle_name": "BRADLEY",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-26",
        "last_updated": "2024-06-07",
        "certification_date": "2024-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A20171",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sunshyne Melissa Gray, LCSW
• Green Harbour Pharmacy Inc
• Cheryl Lea Green, MD
• Esther Green
• Irene J Green
• Lorraine Green, CMT
• Salma Mohammadi Green, DO
• Sean Green
• Bruce M Greene, O.D.
• Samuel Greenleaf, PT, DPT

• Family Medicine Physician in Redlands, CA
• Providers in Redlands, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2024; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.