Autumn-Marie L Green, P.A.-C.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085004400 Issued in IL

Practice address

1100 W Central Rd
#200
Arlington Heights, IL 60005-2402

Phone

(847) 392-5440

NPI assigned

Aug 14, 2012

Sex

Female

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

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Oakland Hills Dermatology PC

  • Dermatology Physician
  • Auburn Hills, MI
  • NPI 1619217478
  Medicare reassignment

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

{
    "created_epoch": "1344902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397174400000",
    "number": "1851648448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 W CENTRAL RD",
            "address_2": "#200",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600052402",
            "telephone_number": "847-392-5440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 W CENTRAL RD",
            "address_2": "#200",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600052402",
            "telephone_number": "847-392-5440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "AUTUMN-MARIE",
        "middle_name": "L",
        "name_prefix": "Miss",
        "credential": "P.A.-C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-14",
        "last_updated": "2014-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085004400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Great Lakes Retina, PLLC
• Greater Heights P Medical Services
• Greater Northwest Medical Group
• Carla Greco
• Melissa Greco, APN-CNP
• Bruce Greenberg, M.D.
• Rosalie Greenberger, LCSW
• Sharon Louise Greenburg, PH.D.
• Tamara L. Gregory, APN-CRNA
• Anne Kathleen Grimes, DMD

• Physician Assistant in Arlington Heights, IL
• Providers in Arlington Heights, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2014; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.