NPIMap

Organization Active NPI

Green Clinic LLC

Doing business as Green Clinic Rehabilitation Services

  • Physical Therapy Clinic/Center
  • Ruston, LA
National Provider Identifier
1891801601
Registry record updated Feb 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
GREEN CLINIC LLC
Doing business as
Green Clinic Rehabilitation Services
Practice address
1200 S Farmerville St
Ruston, LA 71270-5941
Phone
(318) 251-6103
Fax
(318) 251-6141
NPI assigned
Aug 22, 2006
Last updated
Feb 13, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
GREEN CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 13, 2019

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

Authorized official

Name
Mrs. India Carroll
Title
Ceo
Phone
(318) 255-3690

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

1200 S Farmerville St
Ruston, LA 71270-5941

Mailing address

PO Box 1594
Ruston, LA 71273-1594
Phone (318) 251-6103

Other names 1

  • Green Clinic Rehabilitation Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050920000235 LA Part B Supplier - Clinic/Group Practice 4789668831 Receives reassigned benefits from 4 practitioners
Practice locations: Jonesboro, LA; Ruston, LA

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
Green Clinic

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.71614

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550016000000",
    "number": "1891801601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1594",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712731594",
            "telephone_number": "318-251-6103",
            "fax_number": "318-251-6141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 S FARMERVILLE ST",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712705941",
            "telephone_number": "318-251-6103",
            "fax_number": "318-251-6141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN CLINIC LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREEN CLINIC",
        "enumeration_date": "2006-08-22",
        "last_updated": "2019-02-13",
        "status": "A",
        "authorized_official_last_name": "CARROLL",
        "authorized_official_first_name": "INDIA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "318-255-3690",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Green Clinic Rehabilitation Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Green Clinic Rehabilitation Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ruston, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.