NPIMap

Individual provider Active NPI

Bryan T Green, MD

  • Gastroenterology Physician
  • Greenwood, SC
National Provider Identifier
1861485963
Registry record updated Jan 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
26714 Issued in SC
Practice address
103 Liner Dr
Greenwood, SC 29646-2311
Phone
(864) 227-3636
Fax
(864) 227-6116
NPI assigned
Aug 24, 2005
Last updated
Jan 28, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 26714 SC Primary

Addresses

Primary practice location

103 Liner Dr
Greenwood, SC 29646-2311

Mailing address

103 Liner Dr
Greenwood, SC 29646-2311
Phone (864) 227-3636

Other identifiers 1

IdentifierTypeStateIssuer
267142MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040810000764 SC Practitioner - GastroenterologyPractitioner - Internal Medicine 7315919362 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
University of South Alabama College of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Digestive Disease Group PAGroup PAC ID 6002887361, 15 clinicians

Practice addresses (Care Compare)

103 Liner Dr
Greenwood, SC 29646-2311
Phone 86422736362222

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy241
Upper gastrointestinal (GI) endoscopy for acid reflux433

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Self Medical Group CurrentSince Jun 6, 2018 Accepting new patients
Self Medical Group CurrentSince Jun 6, 2018 Accepting new patients
Digestive Disease Group PA Gastroenterology CurrentSince Jul 1, 2004 Accepting new patients
Self Medical Group Current Accepting new patients

Locations

75 Remittance Dr
Dept 6764
Chicago, IL 60675

103 Liner Dr
Greenwood, SC 29646
Phone (864) 227-3636

1325 Spring St
Greenwood, SC 29646
Phone (864) 227-4111

2605 Kinard St
Ste 200
Newberry, SC 29108
Phone (803) 276-1866

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1124841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643328000000",
    "number": "1861485963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 LINER DR",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296462311",
            "telephone_number": "864-227-3636",
            "fax_number": "864-227-6116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 LINER DR",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296462311",
            "telephone_number": "864-227-3636",
            "fax_number": "864-227-6116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "BRYAN",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-24",
        "last_updated": "2022-01-28",
        "certification_date": "2022-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "SC",
            "license": "26714",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "267142",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenwood, SC

Sources for this page

Verify at the official NPI Registry.