Individual provider Active NPI

Thomas Justin Green Jr., M.D.

  • Diagnostic Radiology Physician
  • Daytona Beach, FL
National Provider Identifier
1942207709
Registry record updated Oct 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
0101102736 Issued in VA
Practice address
1673 Mason Ave
Suite 305
Daytona Beach, FL 32117-5515
Phone
(386) 274-7118
Fax
(386) 274-6173
NPI assigned
Jul 7, 2005
Last updated
Oct 1, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2025

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

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging Physician 2085B0100X ME 86894 FL
Neuroradiology Physician 2085N0700X ME 86894 FL
Nuclear Radiology Physician 2085N0904X ME 86894 FL
Pediatric Radiology Physician 2085P0229X ME 86894 FL
Diagnostic Radiology Physician 2085R0202X 103916 GA
Diagnostic Radiology Physician 2085R0202X 0101102736 VA Primary
Diagnostic Radiology Physician 2085R0202X ME86894 FL
Therapeutic Radiology Physician 2085R0203X ME 86894 FL
Vascular & Interventional Radiology Physician 2085R0204X ME86894 FL
Diagnostic Ultrasound Physician 2085U0001X ME 86894 FL

Addresses

Primary practice location

1673 Mason Ave
Suite 305
Daytona Beach, FL 32117-5515

Mailing address

1673 Mason Ave Ste 305
Daytona Beach, FL 32117-5516
Phone (386) 274-7118

Other practice location 1

743 Spring St NE
Gainesville, GA 30501-3715
Phone (770) 219-9000

Other practice location 2

2300 Opitz Blvd
Woodbridge, VA 22191-3311
Phone (732) 763-9253

Other practice location 3

400 Health Park Blvd
St Augustine, FL 32086-5784
Phone (904) 819-5155

Other identifiers 2

IdentifierTypeStateIssuer
79205OtherFLBCBS OF FLORIDA
267313400MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, VI, GA3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20041012000404 FL Practitioner - Interventional RadiologyPractitioner - Diagnostic Radiology 9436119898 Reassigns benefits to 14 organizations
I20210607003093 VI Practitioner - Interventional RadiologyPractitioner - Diagnostic Radiology 9436119898 Reassigns benefits to 1 organization
I20251205000445 GA Practitioner - Diagnostic Radiology 9436119898 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional RadiologyAlso: Diagnostic Radiology
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radiology Imaging Associates LLCGroup PAC ID 2466342803, 182 clinicians
Villages Regional Hospital Physician Services LLCGroup PAC ID 0244688893, 198 clinicians
Danville Physician Practices LLCGroup PAC ID 4688606304, 171 clinicians
East Central Florida Outpatient Imaging LLCGroup PAC ID 9830175199, 44 clinicians
Inverness Medical Imaging LLCGroup PAC ID 3870590672, 83 clinicians
Sentara Medical GroupGroup PAC ID 8921903923, 1,396 clinicians

Practice addresses (Care Compare)

101 Health Park Blvd
St Augustine, FL 32086-5777
Phone (904) 819-4707

1041 Dunlawon Ave
Port Orange, FL 32127-7968
Phone (386) 274-7118

10435 SE 170TH PL
Summerfield, FL 34491-8998
Phone (352) 255-3615

110 Health Park Blvd
Saint Augustine, FL 32086-5776
Phone (904) 823-3401

1195 Dunlawton Ave
Port Orange, FL 32127-4745
Phone (770) 219-9000

13102 Wexford Hollow Rd N
Jacksonville, FL 32224-8648
Phone (904) 861-5370

1490 SE Magnolia Ext
Ocala, FL 34471-4443
Phone (352) 732-7400

1620 SW 55TH St Rd
Ocala, FL 34471-0134
Phone (706) 320-3210

1890 Lpga Blvd
Suite 100
Daytona Beach, FL 32117-7135
Phone (386) 274-7118

1890 Lpga Blvd
Suite 110
Daytona Beach, FL 32117-7131
Phone (386) 274-7118

202 Phillips PL
Orlando, FL 32806-1218
Phone (352) 732-7400

2128 Park Ave
Orange Park, FL 32073-5584
Phone (386) 274-6143

303 N Clyde Morris Blvd
Daytona BCH, FL 32114-2709
Phone (386) 274-7118

32656 Webbs Way
Sorrento, FL 32776-9562
Phone (706) 320-3210

351 Town Plaza Ave
Ponte Vedra, FL 32081-5179

400 Health Park Blvd
St Augustine, FL 32086-5784
Phone (904) 819-5155

6225 S Williamson Blvd
Port Orange, FL 32128-6028
Phone (386) 425-4000

70 Turin Ter
Suite 100
Saint Augustine, FL 32092-0849
Phone (904) 819-1200

7091 SW 60TH LN
Ocala, FL 34474-1943
Phone (770) 219-2394

743 Spring Nest
Gainesville, GA 30501-3715
Phone (770) 219-6000

743 Spring St NE
Gainesville, GA 30501-3715

878 Creekwood Dr
Ormond Beach, FL 32174-1445
Phone (706) 320-3210

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.68 of 100Reported as group
Quality
100
Improvement activities
40
Cost
78.28

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
103916GAMDDiagnostic Radiology Physician
0101102736VAMDDiagnostic Radiology Physician
ME 86894FLMDTherapeutic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ocala Health Imaging Services LLC Diagnostic Radiology CurrentSince Sep 20, 2022 Accepting new patients
Advanced Urology Institute, LLC CurrentSince Jan 6, 2025 Accepting new patients
DLP Twin County Physician Practices LLC Diagnostic Radiology CurrentSince Jan 1, 2025 Accepting new patients
Radiology Imaging Associates, LLC Diagnostic Radiology CurrentSince Jan 1, 2016 Accepting new patients
Inverness Medical Imaging LLC Diagnostic Radiology CurrentSince Aug 1, 2022 Accepting new patients
East Central Florida Outpatient Imaging LLC Body Imaging CurrentSince Jul 1, 2008 Accepting new patients
Danville Physician Practices LLC Diagnostic Radiology CurrentSince Jan 1, 2025 Accepting new patients
Sentara Medical Group CurrentSince Apr 1, 2025 Accepting new patients
St. Francis Physician Practices LLC Diagnostic Radiology CurrentSince Jun 18, 2025 Accepting new patients
St Thomas Radiology Associates LLC Body Imaging CurrentSince Oct 23, 2020 Accepting new patients
Timberridge Imaging Center Diagnostic Radiology CurrentSince Aug 9, 2021 Accepting new patients
Medical Imaging Center of Ocala LLP Pediatric Radiology CurrentSince Aug 9, 2021 Accepting new patients
Advanced Urology Institute, LLC CurrentSince Jan 6, 2025 Accepting new patients
Villages Regional Hospital Physician Services LLC CurrentSince May 1, 2025 Accepting new patients
Northeast Georgia Physicians Group Inc CurrentSince Oct 20, 2025 Accepting new patients
Sentara Advanced Imaging Solutions, LLC Diagnostic Radiology CurrentSince Apr 1, 2025 Accepting new patients
East Central Florida Outpatient Imaging LLC Body Imaging Past Accepting new patients
East Central Florida Outpatient Imaging LLC Diagnostic Radiology Past Accepting new patients
East Central Florida Outpatient Imaging LLC Body Imaging Past Accepting new patients
Medical Imaging Center of Ocala LLP Diagnostic Radiology PastSince Feb 11, 2024 Accepting new patients
East Central Florida Outpatient Imaging LLC Diagnostic Radiology Past Accepting new patients
Halifax Healthcare Systems Inc Diagnostic Radiology Past Accepting new patients
East Central Florida Outpatient Imaging LLC Diagnostic Radiology Past Accepting new patients
East Central Florida Outpatient Imaging, LLC Body Imaging Past Accepting new patients
East Central Florida Outpatient Imaging, LLC Diagnostic Radiology Past Accepting new patients
East Central Florida Outpatient Imaging LLC Body Imaging Past Accepting new patients
East Central Florida Outpatient Imaging, LLC Body Imaging Past Accepting new patients
St. Thomas Radiology Associates, LLC Diagnostic Radiology Past Accepting new patients
East Central Florida Outpatient Imaging, LLC Body Imaging Past Accepting new patients

Locations (25 of 31)

1673 Mason Ave
Ste 305
Daytona Beach, FL 32117
Phone 3862747118 ext. 7704

1890 Lpga Blvd
Ste 100
Daytona Beach, FL 32117

1890 Lpga Blvd
Ste 110
Daytona Beach, FL 32117
Phone (386) 274-5454

303 N Clyde Morris Blvd
Daytona Beach, FL 32114
Phone (386) 425-2285

577 N Williamson Blvd
Daytona Beach, FL 32114

3048 S Atlantic Ave
#102
Daytona Beach Shores, FL 32118

3400 E Halifax Crossing Blvd
Ste 170
Deltona, FL 32725

2105 Highway 44 W
Inverness, FL 34453
Phone (352) 419-4818

609 W Highland Blvd
Inverness, FL 34452
Phone (352) 726-9707

4211 Van Dyke Rd
Lutz, FL 33558
Phone (813) 443-2010

506 Palmetto St
New Smyrna Beach, FL 32168
Phone (386) 427-9554

1490 SE Magnolia Ext
Ocala, FL 34471
Phone (352) 512-9703

2300 SE 17th St
Ste 800
Ocala, FL 34471
Phone (352) 690-8403

9521 SW Highway 200
Ocala, FL 34481
Phone (352) 351-7500

2128 Park Ave
Orange Park, FL 32073
Phone (904) 264-9922

21 Hospital Dr
Ste 130
Palm Coast, FL 32164
Phone (386) 445-4400

3 Pine Cone Dr
Ste 101
Palm Coast, FL 32137
Phone (386) 446-5200

3202 N Park Rd
Plant City, FL 33563
Phone (813) 757-1200

1195 Dunlawton Ave
Port Orange, FL 32127
Phone (386) 763-5300

1041 Dunlawton Ave
Pt Orange, FL 32127
Phone (386) 322-4700

6901 Simmons Loop
Riverview, FL 33578
Phone (813) 302-8000

190 Southpark Blvd
Ste 101
St Augustine, FL 32086
Phone (904) 827-9191

400 Health Park Blvd
St Augustine, FL 32086
Phone (904) 819-4300

10435 SE 170th Pl
Summerfield, FL 34491
Phone (352) 245-7788

3001 W Mlk Blvd
Tampa, FL 33607
Phone (813) 361-6778

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/19847/brand/3/csg/21/fhir/r4
  • FHIR API: https://app.meldrx.com/api/fhir/uc41222_advuroswflorida
  • Direct secure messaging: tgreen742020@direct.shands.ufl.edu

Organizations & group practices 29

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.

View all 29

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": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759276800000",
    "number": "1942207709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1673 MASON AVE STE 305",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321175516",
            "telephone_number": "386-274-7118",
            "fax_number": "386-274-6173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1673 MASON AVE",
            "address_2": "SUITE 305",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321175515",
            "telephone_number": "386-274-7118",
            "fax_number": "386-274-6173"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "743 Spring St NE",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "GA",
            "postal_code": "305013715",
            "country_code": "US",
            "telephone_number": "770-219-9000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2300 Opitz Blvd",
            "address_purpose": "LOCATION",
            "city": "Woodbridge",
            "state": "VA",
            "postal_code": "221913311",
            "country_code": "US",
            "telephone_number": "732-763-9253",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "400 Health Park Blvd",
            "address_purpose": "LOCATION",
            "city": "St Augustine",
            "state": "FL",
            "postal_code": "320865784",
            "country_code": "US",
            "telephone_number": "904-819-5155",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREEN",
        "first_name": "THOMAS",
        "middle_name": "JUSTIN",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2025-10-01",
        "certification_date": "2025-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "FL",
            "license": "ME 86894",
            "primary": false
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "FL",
            "license": "ME 86894",
            "primary": false
        },
        {
            "code": "2085N0904X",
            "taxonomy_group": "",
            "desc": "Radiology, Nuclear Radiology",
            "state": "FL",
            "license": "ME 86894",
            "primary": false
        },
        {
            "code": "2085P0229X",
            "taxonomy_group": "",
            "desc": "Radiology, Pediatric Radiology",
            "state": "FL",
            "license": "ME 86894",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "GA",
            "license": "103916",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "VA",
            "license": "0101102736",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "ME86894",
            "primary": false
        },
        {
            "code": "2085R0203X",
            "taxonomy_group": "",
            "desc": "Radiology, Therapeutic Radiology",
            "state": "FL",
            "license": "ME 86894",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "FL",
            "license": "ME86894",
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "FL",
            "license": "ME 86894",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FLORIDA",
            "identifier": "79205",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "267313400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Daytona Beach, FL

Sources for this page

Verify at the official NPI Registry.