NPIMap

Individual provider Active NPI

Kelly Douglas Green, MD

  • Neurological Surgery Physician
  • Searcy, AR
National Provider Identifier
1912050980
Registry record updated Jan 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
E-9196 Issued in AR
Practice address
2900 Hawkins Dr
Searcy, AR 72143-4802
Phone
(501) 278-2800
Fax
(501) 278-3073
NPI assigned
Jan 20, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 2002010422 MO
Neurological Surgery Physician 207T00000X E-9196 AR Primary

Addresses

Primary practice location

2900 Hawkins Dr
Searcy, AR 72143-4802

Mailing address

2900 Hawkins Dr
Searcy, AR 72143-4802
Phone (501) 278-2800

Other practice location 1

1115 Alaska St
Suite 212
West Plains, MO 65775-2061
Phone (417) 255-9700

Other identifiers 1

IdentifierTypeStateIssuer
1159308OtherCAQH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, AR2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100916000284 MO Practitioner - Neurosurgery 2365338332 Reassigns benefits to 1 organization
I20200915001493 AR Practitioner - Neurosurgery 2365338332 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
University of Missouri, Columbia School of Medicine, 1992
Medicare assignment
May accept Medicare assignment
Group practices
White County Medical CenterGroup PAC ID 4880688654, 182 clinicians

Practice addresses (Care Compare)

2900 Hawkins Dr
Searcy, AR 72143-4802
Phone (501) 278-2800

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion49
Laminectomy or laminotomy (partial removal of spine bones)33

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ozarks Medical Center CurrentSince Jul 27, 2011 Accepting new patients
White County Medical Center CurrentSince Sep 1, 2020 Accepting new patients
White County Medical Center CurrentSince Sep 1, 2020 Accepting new patients
Ozarks Medical Center CurrentSince Jul 27, 2011 Accepting new patients
Arkansas Health Group Current Accepting new patients
Ozarks Neurosurgical Associates LLC Neurological Surgery PastSince Oct 10, 2002 Accepting new patients
White County Medical Center Past Accepting new patients

Locations

2900 Hawkins Dr
Searcy, AR 72143
Phone (501) 278-2800

1115 Alaska St
Ste 212
West Plains, MO 65775
Phone (417) 255-9700

1100 N Kentucky Ave
West Plains, MO 65775
Phone (417) 257-5959

Interoperability endpoints

  • Direct secure messaging: kellydouglasgreen@omcmo.allscriptsdirect.net

Organizations & group practices 7

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.

Hospital & facility affiliations 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1169251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610064000000",
    "number": "1912050980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 HAWKINS DR",
            "city": "SEARCY",
            "state": "AR",
            "postal_code": "721434802",
            "telephone_number": "501-278-2800",
            "fax_number": "501-278-3073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 HAWKINS DR",
            "city": "SEARCY",
            "state": "AR",
            "postal_code": "721434802",
            "telephone_number": "501-278-2800",
            "fax_number": "501-278-3073"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1115 Alaska St",
            "address_2": "Suite 212",
            "address_purpose": "LOCATION",
            "city": "West Plains",
            "state": "MO",
            "postal_code": "657752061",
            "country_code": "US",
            "telephone_number": "417-255-9700",
            "fax_number": "417-255-9958",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREEN",
        "first_name": "KELLY",
        "middle_name": "DOUGLAS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-20",
        "last_updated": "2021-01-08",
        "certification_date": "2021-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MO",
            "license": "2002010422",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "AR",
            "license": "E-9196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "1159308",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Searcy, AR

Sources for this page

Verify at the official NPI Registry.