Individual provider Active NPI

Adam W. Green, MD

  • Pain Medicine (Anesthesiology) Physician
  • Bentonville, AR
National Provider Identifier
1861620213
Registry record updated Dec 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
E-8330 Issued in AR
Practice address
3101 SE 14TH St
Bentonville, AR 72712-4900
Phone
(479) 986-6199
Fax
(479) 636-0371
NPI assigned
Jun 24, 2009
Last updated
Dec 4, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X E-8330 AR
Pain Medicine (Anesthesiology) Physician 207LP2900X E-8330 AR Primary

Addresses

Primary practice location

3101 SE 14TH St
Bentonville, AR 72712-4900

Mailing address

PO Box 776084
Chicago, IL 60677-6084
Phone (314) 543-6979

Other identifiers 3

IdentifierTypeStateIssuer
204518001MedicaidAR
1861620213MedicaidMO
P01507946OtherARRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140625000463 AR Practitioner - Pain Management 6103041694 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pain Management
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Hospital RogersGroup PAC ID 3072570142, 5 clinicians

Practice addresses (Care Compare)

3101 SE 14TH St Pain Management Highw
Bentonville, AR 72712-4900
Phone 47998661994900

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E-8330ARMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesia Services of Benton County PA Anesthesiology CurrentSince Jul 15, 2014 Accepting new patients
Mercy Health Northwest Arkansas Communities Current Accepting new patients
Mercy Hospital Rogers CurrentSince Jan 10, 2024 Accepting new patients
Mercy Health Northwest Arkansas Communities CurrentSince Dec 1, 2023 Accepting new patients
Mercy Health Northwest Arkansas Communities CurrentSince Sep 1, 2024 Accepting new patients
Mercy Health Northwest Arkansas Communities CurrentSince Dec 1, 2023 Accepting new patients

Locations

3101 SE 14th St
Bentonville, AR 72712
Phone (479) 631-2100

2710 S Rife Medical Ln
Rogers, AR 72758
Phone (479) 338-8000

Interoperability endpoints

  • Direct secure messaging: agreen491190@directc.mercy.net

Organizations & group practices 6

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 1

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": "1245801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701648000000",
    "number": "1861620213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776084",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776084",
            "telephone_number": "314-543-6979",
            "fax_number": "314-364-6321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3101 SE 14TH ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727124900",
            "telephone_number": "479-986-6199",
            "fax_number": "479-636-0371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "ADAM",
        "middle_name": "W.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-24",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "AR",
            "license": "E-8330",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "AR",
            "license": "E-8330",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "204518001",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1861620213",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01507946",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bentonville, AR

Sources for this page

Verify at the official NPI Registry.