Charles C Greene MD PHD PA

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

Legal business name

CHARLES C GREENE MD PHD PA

Practice address

11512 Lake Mead Ave
Ste 531
Jacksonville, FL 32256-9680

Phone

(904) 419-2054

NPI assigned

Aug 31, 2012

Organization subpart

No

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

Authorized official

Name

Charles C Greene

Title

Owner

Phone

(904) 419-2054

Specialties & licenses 1

Addresses

Other names 1

• Jacksonville ENT Surgery Center Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Charles C Greene MD PHD PA

  • Otolaryngology Physician
  • Jacksonville, FL
  • NPI 1457600769

  O20130307000132

  Same enrollment
• Charles C Greene MD PHD PA

  • Otolaryngology Physician
  • Lake City, FL
  • NPI 1598014805

  O20130307000132

  Same enrollment
• Charles C Greene MD PHD PA

  • Otolaryngology Physician
  • Jacksonville, FL
  • NPI 1609125913

  O20130307000132

  Same enrollment

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Andrew Ahn, M.D.

  • Otolaryngology Physician
  • Gainesville, FL
  • NPI 1265752406
  NPD
• Kimberly Ann Baird, ARNP

  • Family Nurse Practitioner
  • Jacksonville, FL
  • NPI 1083993703
  NPD

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

{
    "created_epoch": "1346371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369872000000",
    "number": "1942559265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 864935",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328864935",
            "telephone_number": "904-419-2054",
            "fax_number": "904-419-2057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11512 LAKE MEAD AVE",
            "address_2": "STE 531",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322569680",
            "telephone_number": "904-419-2054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES C GREENE MD PHD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-31",
        "last_updated": "2013-05-30",
        "status": "A",
        "authorized_official_last_name": "GREENE",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-419-2054"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jacksonville ENT Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michael Charette
• Polly A. Charette, LCSW
• Kayla Charland, CF SLP
• Charles C Greene MD PHD PA
• Charles C Greene MD PHD PA
• Charles C Greene, MD, PHD
• Charles M Edwards Jr DMD PA
• Charles M Edwards Jr DMD PA
• Charles N. Howell, Jr. PA
• Charles P. Adams Jr. MD PA

• Otolaryngology Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Otolaryngology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2013; 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.