Active NPI
Edmund Green, LMT
- Massage Therapist
- Mentor, OH
National Provider Identifier
1861195703
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 33.021189
- Practice address
- 8500 Station St Ste 300D
Mentor, OH 44060-4963 - Phone
- (216) 849-1079
- Fax
- (888) 312-2672
- NPI assigned
- Mar 22, 2023
- 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 |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 33.021189 | OH | Primary |
Addresses
Primary practice location
8500 Station St Ste 300D
Mentor, OH 44060-4963
Mailing address
3522 W 127TH St
Cleveland, OH 44111-3502
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 |
|---|---|---|---|
| 33.021189 | OH | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679443200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679443200000",
"number": "1861195703",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3522 W 127TH ST",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441113502"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8500 STATION ST STE 300D",
"city": "MENTOR",
"state": "OH",
"postal_code": "440604963",
"telephone_number": "216-849-1079",
"fax_number": "888-312-2672"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "EDMUND",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-03-22",
"last_updated": "2023-03-22",
"certification_date": "2023-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OH",
"license": "33.021189",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mentor, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.