Active NPI
William Macgregor Green, MD
- Emergency Medicine Physician
- South Lake Tahoe, CA
National Provider Identifier
1871591099
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- G27289
- Practice address
- 2170 South Ave
South Lake Tahoe, CA 96150-7026 - Phone
- (530) 543-5968
- Fax
- (530) 543-8683
- NPI assigned
- Jul 12, 2005
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | G27289 | CA | Primary |
Addresses
Primary practice location
2170 South Ave
South Lake Tahoe, CA 96150-7026
Mailing address
1111 Emerald Bay Rd
South Lake Tahoe, CA 96150-6207
Phone (530) 543-5659
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871591099 | Medicaid | CA |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G27289 | CA | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tahoe Emergency Physicians Medical Corporation | Emergency Medicine | Past | Accepting new patients |
| Barton Healthcare System | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Rural Health Clinic/Center
- South Lake Tahoe, CA
- NPI 1053310326
-
- Emergency Medicine Physician
- South Lake Tahoe, CA
- NPI 1104937408
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348099200000",
"number": "1871591099",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1111 EMERALD BAY RD",
"city": "SOUTH LAKE TAHOE",
"state": "CA",
"postal_code": "961506207",
"telephone_number": "530-543-5659",
"fax_number": "530-541-8723"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2170 SOUTH AVE",
"city": "SOUTH LAKE TAHOE",
"state": "CA",
"postal_code": "961507026",
"telephone_number": "530-543-5968",
"fax_number": "530-543-8683"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "WILLIAM",
"middle_name": "MACGREGOR",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-12",
"last_updated": "2012-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "CA",
"license": "G27289",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1871591099",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in South Lake Tahoe, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.